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DISSERTATION 



ON 



THE PATHOLOGY 



OF THE 



HUMAN FLUIDS 



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INAUGURAL DISSERTATION 



THE PATHOL OG Y 



OF THE 



HUMAN FLUIDS 



BY JACOB DYCKMAN, A. B. 

MEMBER OF THE MEDICAL AND SURGICAL SOCIETY OF THE 
UNIVERSITY OF NEW-YORK. 



Nee vitE solum sanguis autor est ; sed pro ejus vario discrimine, sanitatis etiam, snorborumque 
causae contingunt, Harvey. 



NEW-YORK: 

PRINTED FOR THE AUTHOR BY VAN WINKLE AND WILEY S 

Corner of Wall and New-streets. 



1814 



- 



AN 
INAUGURAL DISSERTATION 

ON 

THE PATHOLOGY 

OF THE 

HUMAN FLUIDS. 

SUBMITTED 
TO THE PUBLIC EXAMINATION 



OF THE 

j^/ — TRUSTEES OP THE COLLEGE OF PHYSICIANS AND SURGEONS 
OF THE UNIVERSITY OF THE STATE OF NEW-YORK, 



SAMUEL BARD, M. D. PRESIDENT, 



FOR THE 



Degree of Doctor of Medicine, 

On the 4th day of May, 1813. 



70 e J 



TO 

DAVID HOSACK, M. D. 

F» L. S. LONDON ; 

Frofessor of the Theory and Practice of Physic and Clinical Medicine in the 
University of the State of New- York; Vice President of the Literary and Phi- 
losophical Society of New York; Fellow of the American Philosophical Society, 
and of the College of Physicians at Philadelphia; Member of the Literary and 
Philosophical Society of Preston; Honorary Member of the Royal Medical and 
Physical Societies of Edinburgh ; Corresponding Member of the Medical So- 
ciety of London, and of the Massachusetts Historical Society, S{c. 

Sir, 

To you I dedicate the following Dissertation. With 
much pleasure I embrace the present opportunity of 
acknowledging the obligations, which have arisen from a 
long and faithful course of instruction, imparted to me in 
your private medical school ; and most cheerfully do I thus 
make public those feelings of gratitude and personal regard 
which I have ever cherished since the relationship of pre- 
ceptor and pupil has existed between us. But, independent 
of these considerations, I know no one to whom with so 
much propriety these pages can be inscribed as to you. 
They are written in support of those fundamental principles 
which have been inculcated by the most eminent philo- 



Vlll 

sophers who have adorned the science of medicine, and 
which you, Sir, in your professorial lectures in the University, 
have illustrated with distinguished ability and success. 

Convinced, as I am, that these principles are founded in 
truth, and will lead in their consequence to important results 
in practice, I have endeavoured to adduce such additional 
proofs in their support as some small share of reading and 
observation have enabled me to offer. Should you do 
me the honour to approve this little essay, it will aiford me 
the most ample and satisfactory compensation for all my 
labours. 

With sentiments of the highest respect and esteem, I 
remain, 

Sir, 

Your friend and 

humble servant, 

JACOB DYCKMAN 



TO 



JOHN W. FRANCIS, M. D. 

Professor of Materia Medica in the University of Vie State of New-York ; Member 
of the Society for the Promotion of Useful Arts in the State of New- York, and 
of the New- York Historical Society; Corresponding Member of the Massachu- 
setts Historical Society ; Fellow of the Literary and Philosophical Society of 
New-York, fyc. 

Sir, 

I have prefixed your name to this performance, in 
commemoration of the friendship which has, for many years, 
existed between us, and as a testimony of the respect which 
I entertain for your professional standing, and of that esteem 
I cherish for the uniform integrity and purity of your moral 
character. Permit me here to express the wish, that your 
success in promoting the best interests of that liberal and en- 
lightened profession of which you are a member, may 
be commensurate with your talents and unremitted exer- 
tions ; and that the career so auspiciously commenced may 
remain unchecked by misfortune or reverse. 

In perfect sincerity, and with sentiments of the truest per- 
sonal regard, I subscribe myself 

Your friend, 

J. DYCKMAN. 
2 



PREFACE, 



The object of the following Dissertation is to exhi- 
bit a concise and systematic Pathology of the Human 
Fluids, or a view of their various morbid affections, with 
their differences, causes, and effects. The present inquiry 
relates more especially to the blood, or vital fluid, which 
is not only universally distributed throughout the body, 
but is the source from which all the other humours 
are derived. When the blood, therefore, becomes viti- 
ated, the secretions will necessarily partake of the affec- 
tion. 

All the disorders of the fluids, considered in themselves, 
have a reference either to their quantity or their quality. 
The subject matter of these pages has, accordingly, been 
arranged under two general divisions : the first of which 
embraces the morbid qualities of the fluids. These, 
again, may be comprised under three heads ; morbid 
fluidity, acrimony, and putrescency. The second relates 
to the morbid quantity of the fluids; under which head 
are considered the doctrines of Plethora. 



Xli PREFACE. 

Iu perusing the following pages, it will be seen, that the 
author has made constant reference to the writings which 
he has consulted. His motive in so doing was not only 
to give credit to the intellectual labours of others, but 
also to present the original authorities upon which any 
facts and opinions are supported, and to direct the reader 
to any further illustration which they may afford. 

It may here be proper to remark, that the present Dis- 
sertation was originally submitted, in manuscript, to the 
examination of the Trustees of the College of Physicians 
and Surgeons, in May, 1813, for the purpose of receiving 
the honours of the medical doctorate in the University of 
New-York. Believing the doctrines which he then at- 
tempted to maintain, to be founded on well-known physio- 
logical and pathological principles, and eminently calcu- 
lated to advance the practical interests of the profession, 
the author was afterwards induced to enter more fully into 
an illustration and defence of the tenets he had espoused. 

It would be unnecessary here to offer the various rea- 
sons that have induced the author to adopt the opinions 
attempted to be supported in the following pages. His 
reasons are, with more propriety, unfolded in the 
course of the work. When he first entered upon the 
consideration of this inquiry, he entertained no particular 
sentiments concerning the result. He owes his convic- 
tion of the truth and practical importance of the prin- 



PREFACE. Xlli 

ciples he now supports, to a patient investigation of the 
subject, and, he believes, to an impartial and unpreju- 
diced examination of facts, and of the observations 
and opinions of the most approved writers. 

Of the numerous topics of pathological investigation, few 
are more deserving attention than the doctrine of the 
fluids ; and from the manner in which the inquiry has been 
conducted, none, perhaps, has afforded more abundant 
room for animadversion. Hence, whether the solids or 
fluids are primarily affected, and how far these latter are 
ever the subject of disease, are questions which have been 
discussed in all the bitterness of controversy. Discus- 
sion, though in an eminent degree calculated to lead to 
the discovery and development of truth, loses much of 
its importance in this respect, when influenced by preju- 
dice, or by passion. " Science disdains the spirit of party, 
and philosophy herself weeps at the madness of secta- 
rians."* 

The author must again repeat, that he cannot but be- 
lieve that the doctrines attempted to be supported in the 
present performance, as they are founded upon a general, 
and not a partial view of the human fabric, will lead to 
consequences the most auspicious to humanity. Empires 
and science are subject alike to revolution, and as the for- 



* Dr. John W. Francis. 



Xiv PREFACE. 

mer, after being the victim of usurpation, not unfrequently 
again revert to legitimate dominion, so is it incident to the 
latter to revive those well grounded truths which may 
have been exploded by the fashionable theories, or the 
prevailing philosophy, of the day. It may here, too, be 
observed, such has been the force of authority since tho 
appearance of the systematic writings of Cdllen, and still 
more lately, those of Brown, Darwin, and their disciples, 
that the teachers in the most celebrated schools of medicine 
have been wholly regardless of the fluids as a constituent 
and essential part of the animal economy. May the author 
be permitted to add, that the honour of restoring this pa- 
thological principle, as founded upon the most prominent 
facts which the science affords, and the most striking re- 
sults which animal chemistry presents, has been reserved 
for this country, and for the present teacher of the Theory 
and Practice of Physic in the University of New-York. 

THE AUTHOR. 

New-York, March 4, 1814. 



CONTENTS, 



PAGE 

Preface, H 

Introduction, . 17 

ON THE MORBID QUALITIES OF THE FLUIDS. 

Natural History of the Blood, „ 36 

Morbid Fluidity of the Blood, ..... 68 

Morbid Acrimonies of the Blood, .... 93 

Dissolved and Putrescent State of the Blood, . . 13S 

Action of Specific Morbid Poisons, . . . . 184 

ON THE MORBID QUANTITY OF THE FLUIDS. 

Plethora, ......... 200 

Diseases of Plethora, . . " " ■ . . . . 225 



DISSERTATION 



ON 



HE PATHOLOGY 



OP THE 



HUMAN FLUIDS., 



1JVTR OJD UCTION. 

To explore the nature and causes of disease; 
to trace their operation upon the animal ma- 
chine ; to determine those morbific dispositions 
of body which must concur with the remote or 
possible causes before any one general symptom 
of disease can take place; to ascertain the 
changes or conditions in the state of the corpo- 
real frame which are essential to, and invariably 
productive of, the different species of morbid, 
affections, is one of the most important, and, at 
the same time, one of the most difficult under- 
takings in the whole science of medicine^ 

3 



1# PATHOLOGY OF THE 

Many are the ingenious theories and hypothe- 
ses, many the plausible systems that have been 
formed on this subject, and which have been 
successively published from the earliest periods 
of physic down to the present time. Of these 
several systems, each has had its votaries, who 
have for a time supported its credit, and given 
to its doctrines a gay and flourishing appear- 
ance ; but they have at length yielded to others 
more novel, or more captivating, or, perhaps, 
better fitted to the state of medicine, and to 
the prevailing philosophy of the age. Such 
has uniformly been the fate of nearly all the 
various doctrines of medicine that have as yet 
been offered to the world; principally from 
their having been the offspring of conjecture, 
without the support of facts and observations, 
the only grounds and principles of all true and 
rational philosophy. But this solid foundation 
appears to be w r anting in most of the several 
systems of physic hitherto invented ; of conse- 
quence, time betrays their weakness, and they 
fail of themselves to ruin. The philosophy of 
the ancients, indeed, was so extremely limited 
with regard to our internal economy, or the 



HUMAN FLUIDS. 19 

laws by which our animated system is governed, 
that they had not sufficient data for establish- 
ing any thing of a general pathology explanatory 
of the various morbid conditions of the human 
frame. And the moderns, notwithstanding their 
superior advantages, and the favourable turn to 
our medical philosophy, have not made such 
advances as might have been expected. We are 
still greatly in the dark with regard to the in- 
ternal economy, over many of the operations of 
w T hich nature appears to have drawn an im- 
penetrable veil. 

The whole material world has been, not im- 
properly, divided into solids and fluids, as being 
the only essential states of matter we are able 
to observe. In compliance with the mode of 
expression usual among medical writers, the 
corporeal part of man may be said to be com- 
posed of both these conditions of matter, being 
nothing else but a fine contexture of solids and 
fluids, which are tilted by the laws of nature for 
different purposes, and by their various motions 
are productive of all the phenomena of animal 



20 PATHOLOGY OF THE 

life.* And in correspondence with the views 
which physicians of different ages of the 
world have taken of the animal body, and of 
the influence which these two component parts 
were supposed to exert upon the organized 
living system, the seat and cause of disease 
have, at different periods, been almost exclusive- 
ly referred either to the solids or to the fluids. 

But, as an ingenious authorf has observed, 
there are fashions in physic as well as in every 
thing else, and it is to be regretted that in our 
transition from one theory to another, we run 
too much into extremes. For here it falls out, 
as in most other disputations, we err in carrying 
things too far. The humoral pathology, as it 
is called, under various modifications, prevailed 
universally in the schools of physic for a great 
length of time. Diseases were supposed to have 



* Corpus humanum constat e partibus solidis etfluidis, quarum 
mutua actione, functiones vivi hominis (quatenus corporeee sint) 
peraguntur. Gregory, Conspectus Medicinw, ^ 69. 

i Walker, An Inquiry into the Small Pox, p. 59. 



HUMAN FLUIDS. 21 

their seat chiefly, if not entirely, in the animal 
fluids or humours; and to their changes or dis- 
ordered conditions were principally attributed 
all morbid phenomena. This doctrine, or 
opinion, notwithstanding it gave a very impro- 
per and fallacious idea of many diseases, was so 
generally received, and so warmly espoused, 
that although others were occasionally pro- 
posed, they were, by the generality of physi- 
cians, considered only as innovations, and were, 
in general, but of short duration. 

Of late, however, the opposite doctrine ap- 
pears to have been generally received, and it has 
now become fashionable to refer all morbid 
phenomena to the different affections or condi- 
tions of the solids, without any regard to the 
influence of the living and circulating humours. 
The respective writings of Willis* and Bag- 
Livif seem to have given the first hint, that a 
consideration of the different affections or con- 
ditions of the living solids, would, in general, 



* Pathologia Cerebri et Nervorum. 
f De fibra motrici et morbosa. 



22 PATHOLOGY OF THE 

afford the most probable grounds of disease, 
and a more rational and satisfactory explana- 
tion of many morbid phenomena, than that of 
the derangements or disordered conditions of 
the animal fluids. The celebrated Hoffman,^ 
however, was the first who put physicians in 
the proper train of investigation, reduced this 
doctrine to any tolerably clear and simple form, 
and satisfactorily pointed out any extensive 
application of it in the explanation of diseases, 
or in unfolding the various occurrences in the 
morbid conditions of the animal body. But it 
is in the w 7 ritings of the learned and ingenious 
CuLLENf that a far more bold and general ap- 
peal is made to the agency of the living solids., 
or moving powers of the body, and their various 
affections, as constituting the essence of much 
the greater number of diseases. And, lastly, 
in the systematic works of Brown J and Dar- 
win,$ all consideration of the changes or condi- 



* Medicin. Rational. System, torn. 3. sect. i. cap. 4. 
f First Lines. 
X Elementa Medicina?. 
^> Zoonomia, or the Laws of Organic Life. 
1 



HUMAN FLUIDS. 23 

lions of the humours, as the origin of disease, is 
wholly rejected, and the phenomena of life, 
whether in a state of health or disease, are ex- 
clusively referred to the various action of the 
moving fibres, and to the agency of the nervous 
energy, or sensorial power, resident in the 
living solids. 

From a due consideration of the nature, func- 
tions, and composition of the living human body, 
to us it appears that these two opposite doc- 
trines, namely, that of the fluids and that of the 
solids, have both been carried too far ; and while 
one party have supported one opinion, and the 
other the very reverse, the probability is, that 
no disease of the constitution can take place 
without involving every part of our system, af< 
fecting the condition of the solids as well as that 
of the fluids. For such is the universal sym- 
pathy, and such the continual intercourse inces- 
santly kept up between these component parts 
of our body, that in health they mutually assist 
and support each other, and are fitted by the 
Jaws of nature for the different purposes of the 
animal economy ; in like manner, in the morbid 



24 PATHOLOGY OF THE 

state they sympathize together, and reciprocally 
communicate their affections. 

By the human body we are to understand, 
what it really is, a whole, in which the various 
parts have different and various properties, 
which compel them to act in conformity to 
these same properties, and which keep them in 
perpetual action and reaction on each other. 
Its various instruments and powers are but parts 
of one stupendous whole, and so intimately con- 
nected, and so mutually influencing the actions 
and conditions of each other, as to produce but 
one continued and perpetual circle of motions, 
some of which are influenced by others, and 
could never be completed without all their parts 
or instruments being duly arranged, and in their 
proper places. For example, the blood, which 
is the primogenial part of the animal embryo,* 
is the first cause that excites the heart into ac- 
tion,! and by its perpetual stimulus or impression, 



* Harvey, De Generatione Animalium. 

f Certumque est, visiculam dictam, ut et cordis auriculam 
postea, (unde pulsatio primum incipit) a distendente sanguine, ad 
constrictionis motum irritari. Ibid. Exercit. 51. 



HUMAN FLUIDS. 25 

forever after determines and keeps up the mo- 
tions of this organ. 1 * And again, the heart it- 
self borrows its motory power from the nervous 
energy, which latter presupposes the circulation 
of the blood, and its constant impression upon 
the brain and spinal marrow. And so of all the 
other principal parts of our system. Hence the 
beauty and perfection of the animal circle! 
The living and moving solids, by their energies 
and action, propel the blood and humours, and 
preserve them in a renovated and healthy state, 
whilst these again, by stimulating the vessels 
which contain them, keep up their due and ne- 
cessary motions, and at the same time are fraught 
with what is necessary to replace the various 
expenditures of the system, whether of sub- 
stance, vigour, or vitality. Hence the truth 
of what is so beautifully observed by Hippo- 



* Qui hos experimentorum nostrorum eventus pensitaverit, is 
quidem non dubitabit nobiscum pronunciare, causam, quae cor in 
motum ciet, omnino sanguinem venosum esse: nam enata ea 
causa cor movetur, subtracta quiescit, diminuta motus cordis 
languet, aucta motus intenditur. Haller, Elem. Physiol. Corp, 
Hum. torn. i. p. 495. 

4 



26 PATHOLOGY OF THE 

crates, that " every thing in the human body 
is so disposed in manner of a circle, that you 
will find the end where you would look for the 
beginning, and the beginning where one might 
expect the end."* 

But, notwithstanding all the several powers 
and instruments of the body are necessary to 
the energy and uniform operations of the 
whole, yet certain parts thereof seem to hold a 
primary, and others a subordinate importance. 
Sensation and the circulation of the blood are 
the last signs of life ; and life itself, according to 
a celebrated French physiologist,! is produced 
by an impression of the arterial blood made 
upon the brain and medulla spinalis, or a princi- 
ple resulting from that impression. The ner- 
vous and vascular systems may, therefore, be 
esteemed the prime essentials of life, and the 
immediate cause of the animal motions; and, of 



* EjCto) S~ox,iit dgyjn y.iv ovv ovfif/.iet tivett tov <ru[/.a.ro?, ctKXtt Ttttwa, 
options *'ex» x*/ 5t*'vt* tjTvSutjt kvkkou y&g T-gapsvroc *'g^,j) t>"X si/gs6w. 

He Locis in Homine. 
■}■ Le Gallois. 



HUMAN FLUIDS. 27 

consequence, the consideration of these will 
always form the leading doctrines of true and 
rational pathology. 



From what has been said in the preceding 
pages, it appears that the animal body is a 
machine, delicate in its texture, consisting of 
solids and fluids, which, by their various pro- 
perties and mode of action, are productive of 
all that peculiar assemblage of motion which 
constitutes life; and that health itself consists in 
the regular and equable motions of these com- 
ponent parts, together with proper conditions 
thereof; and that diseases are their aberrations. 



From this general, though imperfect, view of 
the animal economy, it is easy to apprehend 
that the animal motions may be disordered, and 
diseases brought on by a great variety of 
causes: for whatever too much increases or 
diminishes the nervous or vital energy ; what- 
ever too much excites or depresses the actions 
of the moving fibres; whatever renders the 
fibres too dry, elastic, and tense, or too 
moist, flaccid, and weak; whatever over and 



28 PATHOLOGY OF THE 

above increases or diminishes the quantity of 
circulating humours; whatever renders the 
blood too dense, thick, and viscid, or too thin, 
limpid, and serous; whatever loads and im- 
pregnates this fluid with too large a proportion 
of active, acrid, putrescent particles, or with too 
many sluggish, poor, and watery corpuscles; 
whatever creates in the humours a tendency 
towards an alkaline, or putrescent disposi- 
tion; whatever inordinately promotes or re- 
tards any of the secretions or excretions ; and, 
lastly, whatever increases or diminishes the 
force or velocity of the circulation, or augments 
or rebates the vital heat and energy of the body, 
beyond a certain degree, will affect or disturb 
the animal motions, and thus become the pri- 
mary and immediate ^cause of some disease or 
other. 

Seeing, then, the various changes in the 
habit whence disorders may proceed, it would 
seem surprising that diseases are not more fre- 
quent, or that the animal body should be able 
to hold out to extreme old age. But we are to 
recollect " that nature assumes some latitude in 



HUMAN FLUIDS. 29 

her operation? without injury to the body,"* and 
therefore, as Galen| has well remarked, what 
is called health, is neither absolute nor indivisi- 
ble, but admits of considerable latitude ; by vir- 
tue of which the solitary alienation of any one 
part, or small deviations from the natural stand- 
ard of health, seldom affect the integrity of the 
functions ; so that disease only breaks out at last 
when the evil has become more considerable^ 
and been more widely diffused.^ To the pro- 
duction of disease, therefore, as physicians justly 
affirm, there is required a particular combination 
of causes^ no single one, however powerful, 
being sufficient for this purpose, without the 
concurrence of others: and yet that which alone 



* Gardiner, Observations on the Animal Economy, p. 17„ 
f Hon enim absoluta ipsa est, nee indivisibilis simul, quae est 
et dicitur sanitas, verum etiam quae ab hac deficit, modo adhuc 
usibus nostris non sit inepta. Galen, De Sanitate tuenda. 

$ Inest etiam in sanitate robur aliquod, quo se adversus vitia 
singularia tuetur, nee a solitaria cujusvis partis alienatione func- 
tionum suarum tenorem mox perturbari sinit : ut adeo plerura- 
que morbus turn demum erumpat, cum latius se diffudit malum* 
Gaubii Pathologia, ^ 123. 

^ Blane, Diseases of Seamen. 



30 PATHOLOGY OF THE 

produces no visible effect, as Celsus observes* 
often proves extremely efficacious in conjunc- 
tion with others ; so that we in general adjudge 
that to be the cause of a disease which appa- 
rently most contributes to its production.* 

As health consists in a proper harmony and 
regularity of the animal motions; so disease, on 
the contrary, is this harmony destroyed, and 
evidently consists in the production of a new 
series, a new order of motions and things. To 
the regulated and necessary actions which con- 
spire to produce life and health, succeed those 
determinate actions that concur to produce dis- 
ease and dissolution. But all the animal mo- 
tions are the result of the joint influence and co- 
operation of the different solids and fluids of the 
body ; and therefore it is in the changes or dis- 
ordered conditions of either the one or the 
other, or of both these, that we are to look for 



* Nihil omnino ob unam causam fieri, sed id pro causa appre- 
hendi, quod contulisse plurimum videtur. Potest autem id, dum 
solum est, non movere, quod junctum aliis masime movet hi 
Pmfat. lib. i. p. 16. Ed. 1730. 



HUMAN FLUIDS, 31 

the causes of disease. The various affections 
of the living and inert solids, it is true, will be 
found to be the cause of disease much more fre- 
quently than the various state and changes of 
the several animal fluids ; but this surely is no 
good reason for rejecting altogether the agency 
of the latter, or for denying either the possibility 
of a fault in the humours, or, that they are capa- 
ble of affecting, by their different condition, the 
motions or state of the living or inert solids. 
The blood being the true stimulus to the action 
of the heart and arteries, it is easy to understand 
that this fluid will be differently qualified for 
this purpose, according to the different state of 
its sensible or chemical properties. Thus, ceteris 
paribus, a dense, rich blood, will be capable of 
impressing and receiving the force of the heart 
and blood vessels more fully, and, consequently, 
of producing a more general excitement through- 
out the system, and a higher degree of the vital 
heat and motions, than a weak, impoverished, or 
serous blood. It is upon this principle that the 
learned Haller observes, "Calor cum densi- 
tate sanguinis increscit, et cum aquosa ejus te- 
smitate ita minuitur, ut aquosus cruor, etiam ve- 



32 PATHOLOGY OF THE 

hemerter motus, calorem non parem generet, 
aquae exemplo, quse celerrimo motu levissime 
intepescit, et feminarum teneriorum, quas neque 
hysterica? convulsiones, neque febres ad eura 
gradum calefaciunt, qui in sano agricola nasci- 
tur.* But it is deemed unnecessary longer to 
dwell upon the importance of attending to the 
different states of the blood, and the impressions 
which they are capable of making upon the ge- 
neral system. Suffice it to say, that this hu- 
mour is the primitive principle of all animal 
substances, the common origin of all the animal 
solids and fluids; and when it is well consti- 
tuted, and performs its proper office, conveys 
life, motion, vigour, nourishment, in a word, 
health, to every part of the organized machine : 
so, on the contrary, the mass of blood being 
vitiated, or disorderly moved, becomes a source 
of much aggravation to the system, and the 
cause of many morbid effects. That the 
blood and other humours of the body are capa- 
ble of admitting morbid or preternatural quali- 
ties, is a fact demonstrated by daily experience, 

* Haller, Elem. Physiol, torn. 2. p. 150. 






HUMAN FLUIDS, 33 

and the uniform observations of physicians 
of every age and country. The colour, tex- 
ture, consistence, and other sensible qualities 
of the blood, are liable to various altera- 
tions. Sometimes the humours appear to un- 
dergo decomposition in the body, as in vitro. 
In the scurvy, in putrid, malignant, pestilential 
fevers, &c. we observe all the phenomena of a 
degeneration and complete disunion of the dif- 
ferent principles that compose the blood, the 
texture of which in some instances appears to be 
nearly destroyed. In such cases, it seems as if 
the vital principle abandoned the government 
of the corporeal frame, and left the solids and 
fluids to the destructive action of external 
agents ; in consequence of which they tend to 
putrefaction, and become decomposed, as they 
usually do when separated from the body, or 
when the principle of life or animality is ex- 
tinguished. To ascertain these several morbid 
affections of the blood, with their various causes, 
signs, and effects, is the object of the following 
Dissertation. But in conformity with the gene- 
rally received axiom, Rectum est sui et obliqui, 
before entering upon the consideration of the 



34 PATHOLOGY, &C. 

pathology or morbid state of this fluid, it will 
be necessary to offer a few observations on its 
natural history, and its appearances when in a 
sound condition ; by comparing with which its 
qualities and accidents when diseased, it will not 
be difficult to refer the several vitiations to their 
proper heads or classes* 



ON 



THE MORBID QUALITIES 



THE FLUIDS. 



The several vitiations or morbid qualities of 
the circulating fluids, which we are now to con- 
sider, will be comprised under one or the other 
of the following heads; namely, morbid fluidity, 
acrimony, and putrescency. But before we at- 
tempt to establish conclusions from the various 
state of the blood when drawn from diseased 
persons, we must recollect the appearances 
which this fluid exhibits as taken from sound 
persons; and, therefore, previously to entering 
upon the consideration of its diseases, it may be 
proper to premise a few observations on its natu- 
ral and physiological history. 



36 PATHOLOGY OF THE 

Natural History of the Blood. 

The human blood, in its natural and healthy 
state, is a fluid possessed of a considerable 
degree of density and consistence,* has a vis- 
cid and tenacious feel,f a smell somewhat uri- 
nous, and peculiarly animal,J and is to the taste 
sweetish or slightly saline,^ from its containing a 
small quantity of sea-salt, which is sometimes 
discernible by the microscope,|| and therefore 
exists in a free and uncombined state; whence it 
would appear to be an accidental rather than an 
essential or constituent part of the blood. But 
notwithstanding this fluid is somew T hat saltish, 
yet in its healthy state, uninjured by putrefaction, 
or too violent a degree of heat, it is neither 



* "Van Swieten, Comment, in Boerh. Aphor. 5} 1174. 
f Macbride, Theory and Practice of Physic, p. 7. 
% Johnson, Animal Chemistry, vol. i. p. 24. 
^ Hunter, Treatise on the Blood, Inflam. &c. p. 14. 
|| Haller, First Lines, chap. 5. Boerhaave, Institut. Med, 
^ 224. n. 5. 



HUMAN FLUIDS. 37 

alkaline nor acid,* but perfectly bland and 
temperate,f and without the least sensible 
acrimony; for if dropped into the eye it gives 
no pain.J 

Blood is not so fluid as water, but necessarily 
possesses a sort of plastic lentor and tenacity. 
Its specific gravity, according to Mr. Boyle,$ is 
equal to 1040; but from the more recent expe- 
riments of the accurate Jurin,|| it is estimated 
at about 1053. The gravity, as well as the 
consistence of this fluid, may vary very sensibly 
in different persons, according to age, sex, con- 
stitution, season of the year, and a diversity of 
other circumstances. 

The colour, texture, and consistence of recent 
blood is variously affected by different re- 
agents. Its fluidity is increased by alkalis both 



* Schwenke, Hasmatologia, p. 135. Boerhaave, Ele* 
menta Chemise, torn. 2. proc. 114. 
f Hoffman, torn. 2. p. 369. Gaubius, Patholog. ^ 290. &c. 
X Van Swieten, Commentar. ^ 82. 99. 423. &c. 
^ Nat. Hist, of the Blood, Works, vol.iv. p. 167. fol. ed. 1744. 
SI Philos. Trans, No. 361. Jones's Abridgment, vol. v. 



38 PATHOLOGY OF THE 

fixed and volatile, by which it is preserved from 
coagulation. Neutral salts, such as sal Glau- 
beri, common salt, &c. render it in like manner 
more fluid, and retard its coagulation; whilst 
alum coagulates it immediately. It is likewise 
coagulated or rendered more thick by the vi- 
triols of zinc, iron, and copper, by concentrated 
spirit of wine, by the mineral acids, and by most 
of their combinations wiih earthy and metallic 
bodies.* 

But the vegetable acids in general produce 
no coagulation.f Acetum, according to Boer- 
haaveJ and Schwknke,$ rather dissolves or 
attenuates the blood, and hence it is recom- 
mended as a deobstruent by the former. 



* Vide Haller, Elem. Physiol, torn. 2. ; Johnson, Animal 
Chemistry, vol. i. ; Hewson, Experimental Inquiries ; Huxham, 
on Fevers ; Chaptal, Chemistry, part v. ; Boyle, Natural 
History of the Blood ; Boerhaave, Elem. Chem. torn. 2. proc 
127. 

f Haller, in loc. cit. 

% Elem. Chem. torn. 2. proc. 50. 

<} Hsematologia, vel Sanguinis Historia, 



HUMAN FLUIDS. 39 

It would be unnecessary longer to dwell upon 
the effects of reagents upon the blood ; for we 
must not conclude that their effects upon this 
fluid, whilst in the body, and under the control 
of the vital principle, or the action of the heart 
and vessels, would, in all instances, be the same 
as out of it. Beside, most substances which are 
thrown into the stomach, are so changed by the 
action of this viscus, as to have altogether lost 
their original qualities before they can gain ad- 
mission into the circulation. Others, again, are 
less altered thereby ; and some appear to pass 
into the circulation without any change of 
property, where they manifest their qualities, 
and produce effects upon the circulating fluids, 
not dissimilar to what they would when out of 
the body. Of this latter kind appear to be 
many alkaline and saline materials, which are 
altogether indigestible. Sea-salt, accumulated 
in the habit in a certain quantity, has long been 
considered one immediate cause of scurvy;* 
and, indeed, the records of medicine are not 



* Vide Culien, First Lines ; — also Lind on the Scurvy- 



40 PATHOLOGY OF THE 

wanting in facts to show that the texture of the 
blood may be destroyed, and the whole mass 
brought into a dissolved and putrescent state, by 
the abuse of this material.* Similar effects have 
followed the long and abusive use of the lixivial 
or alkaline salts.f 

Human blood is easily putrescent, and that 
most readily in a temperature between 100 and 
110 of Fahrenheit :t which includes the general 
range of febrile heat. Putrefaction is a means 
of entirely destroying the texture and cohesion 
of the blood, and resolving this mild and plastic 
fluid into a thin, acrid, and fetid sanies.^ It soon 
contracts a disagreeable fetor, which increases 
so rapidly as to become, in a few days, nearly 
insupportable ; the crassamentum, in the mean 
time, loses its firmness, and begins to change the 
serum to a darkish red colour, and it finally 



* Percival, Essays, Medical and Experimental, vol. ii. p. 118. 
f Haller, torn. 2. p. 90. Huxhasi, on Fevers, p. 48, 49. SOS. 
i Alexander, Experimental Inquiry, chap. ii. 
^ Haller, torn. 2. p. 89. See also Browne Langrish, 
Modern Theory and Practice of Physic, p. S5&. 



HUMAN FLUIDS. 41 

becomes so dissolved as to leave only a very few 
threads or feces behind ; and in this state it has 
a strong smell of volatile alkali, and effervesces 
with acids.* Putrid blood cannot by any art 
be inspissated, or made to coagulate.f To what 
extent the putrefaction of this fluid may pro- 
ceed in the living body, may perhaps be difficult 
to determine ; but there is evidently a tendency 
or an approximation to this state, in mail}' 
malignant disorders where the cohesion of the 
blood is dissolved, and it is rendered incapable 
of coagulation.^ 

So far with regard to the general appearances 
and properties of blood considered as a whole; 
but physiologists, to enable them the better to 
understand the nature of this fluid, and to ascer- 
tain the various ingredients which enter into its 
composition, have had recourse to the aid of 
chemistry; though it must be acknowledged. 



* Vide Pringle, Diseases of the Army, Append. ; John- 
son, Animal Chem. vol. i. p. 26. ; Haller, First Lines, ^ 139. ; 
Boerhaave, Elem. Chem. torn. ii. &c. 

f Halle r, loc. cit. 

| Huxham, on the Dissolved and Putrid State of the Blood. 



42 PATHOLOGY OP THE 

that chemical analysis exhibits not the true prin- 
ciples of the blood, nor even such as are pro- 
duced in a state of perfect simplicity ; however, 
it is of some importance in enabling us to speak 
more intelligibly concerning various changes 
and combinations that take place in the ani- 
mal fluids. 

Blood is by the force of fire resoluble into 
four species or kinds of matter; namely, aque- 
ous, terrene, saline, and oily or inflammable.* 
But fire acts upon this fluid with a strange 
diversity, according to the degree in which it is 
applied: below 100 down to 50 it attenuates 
and putrefies it. From 100 up to 276 it inspis- 
sates it; and above this degree again, it atte- 
nuates it, and renders it volatile, sharp, and 
alkaline, f 

By a more detailed and elaborate process, 
human blood is found to contain the following 
ingredients ; viz. water, fibrin, albumen, gelatin^ 



* Vide Botle, Nat. Hist, of the Human Blood, vol. iv. ; 
Haller, First Lines, chap. 5. 

\ Boerhaaye, Elena. Chem. torn. ii. prec. 119. 



HUMAN FLUIDS. 43. 

hydro-sulphuret of ammonia, soda, sub-phos- 
phate of iron, muriate of soda, phosphate of 
soda, phosphate of lime ; besides a small portion 
of benzoic acid, which has been detected by 
Proust.* Hales found that blood likewise con- 
tained an aerial Jluid.f 

The blood, by this analysis, is shown to be a 
very heterogeneous aggregate, and to contain 
various fluids or substances, some more ponder- 
ous and tenacious than others, some aqueous, 
some alkaline, others oily or inflammable ; but 
most of them impart to the sanguineous mass a 
putrid or alkalescent tendency. So long, how- 
ever, as these several ingredients duly allay or 
neutralize each other, they are altogether inof- 
fensive to the body. But if, in consequence of 
putrefaction, of too violent a degree of heat and 
motion, or other causes, the crasis of the blood 
be destroyed, or its texture so opened as to dis- 
solve the bond of union among the insensible 
particles, the different salts and oils of the blood 



* Thomson, System of Chemistry, vol. y. p. 602, 
t Hales, Statical Essays, 



44 PATHOLOGY OP THE 

are then allowed to recede from their natural 
combinations, and to run into others, which, 
being opposite to the mild and emollient nature 
of healthy blood, still farther dissolve the crasis 
of this fluid, and increase the disturbance of the 
motions of the living solids. For the blood in 
its natural state is bland, although in some dis- 
eases it is rendered highly acrimonious, and 
almost putrid; as, for example, in scurvy, where 
it corrodes its containing vessels, and runs off 
in profuse hemorrhages from different parts of 
the body : such, too, is the malignity or corrosive- 
ness of the humours in this complaint, as in 
some instances to have forced open the scars of 
wounds, which had been many years healed; 
the calli of fractured bones, which had been 
completely formed for a long while, have been 
entirely dissolved; the cartilages of the sternum 
separated from their junction with the ribs; and 
the epiphyses from the body of the bones.* 



* Vide Lord Anson's Voyage Round the World, by the 
Rev. Mr. Walter ; Lind, on Scurvy ; Rouppe^ De Morbis 
Navigantium ; Mead, Discourse on the Scurvy ; Account of 
Poupart's Dissections, in Philos. Trans, Abridg. vol. v. 



HUMAN FLUIDS. 45 

We are next to take a brief view of the 
nature and properties of the proximate compo- 
nent parts of the blood, as they usually appear 
from spontaneous separation or decomposition. 

Blood, as it flows from the vessels of a healthy 
person, appears to be an homogeneous fluid, of 
a uniform red colour and consistence ; but left 
to itself it soon loses its fluidity, and separates 
into different parts. In the first place it emits 
spontaneously a subtle aqueous vapour, or 
halitus, of a smell something urinous, fatuous, 
or peculiarly animal.* Water impregnated 
with this vapour in a short time contracts a 
putrid odour ;f whence it would appear to be a 
part of the blood highly annualized or loaded 
with septic particles. In health it is mild and 
bland, but acquires an acrimony from disease.J 
As this aroma escapes, the blood which remains, 



* Dumas, Principes de Physiologie, torn. ii. p. 33. 

f Johnson, Animal Chem. vol. i. p. 56. 

J Vapor, ex sanguine exhalans, est mitis, blandus, neque nares, 
jieque oculos afficiens, in statu tamen prsternaturali plane eodem 
modo, ut sudor morbificus et vapor ex ulcere manans atque 
evaporans, acer nares atque oculos ferit. Schwenke, Hcemato- 
log. p. 90. 



46 PATHOLOGY OF THE 

in the mean time, settles into a tremulous coagu- 
lated mass,* which is of different degrees of 
firmness in different subjects.f In a few hours 
more or less, according to different circum- 
stances, this coagulated mass, if kept in a tem- 
perature between 32 and 96 of Fahrenheit, % 
separates into two distinct parts ; the one a light 
greenish yellow, or almost colourless fluid, called 
serum or lymph, in the midst of which floats the 
other, a red solid body, denominated crassamen- 
tum, coagulum, or clot. The cause of this spon- 
taneous decomposition of the blood, when out 
of the vessels, has not hitherto been ascertained. 
According to the experiments of Hewson,§ 
Hunter,|| and others,H it is not essentially con- 
nected with the influence either of air, heat, 
cold, or even of motion or rest. The coagu- 
lation takes place equally in the open air, in 
vacuo, and in close vessels, whether the blood 



* Gaubius, Patholog. ^ 336. 

f Macbride, Theory and Practice of Physic, p. 7, 

X ScHWENKE, IOC. tit. 

^ Experimental Inquiries. 

j| Treatise on the Blood, Inflam. &c. 

? Vide Johnson, Animal Chem. vol. i. 



HUMAN FLUIDS. 47 

be suffered to cool, or be constantly preserved 
at the temperature at which it is when it issues 
from the body ; nor is it prevented by agitation, 
by repose, or by dilution with water. 

The proportion between the serum and cras- 
samentum of the blood, appears to vary much 
in different persons, and even in the same person 
in different circumstances. In health, the most 
common proportion, according to the experi- 
ments and observations of Mr. Boyle,* is equal 
quantities of each. Browne Languish! esti- 
mates the crassamentum at rather more than 
one half of the whole mass of blood. But these 
proportions are by no means constant ; in many- 
cases the crassamentum much exceeds, and at 
other times falls greatly short, of the quantity 
of serum. From a comparison of the observa- 
tions and conclusions of most of those who have 
written with accuracy upon this subject, the 
limits of the ratios of these two substances to 
each other appear to be 1 : 1 and 1 : 4 or 5.$ 



* Nat. Hist, of the Blood, vol. iv. p. 172. 200. 
f Modern Theory and Practice, p. 73, 74. 
t Haller, Elem. Physiol, torn. ii. p. 47. 



48 PATHOLOGY OP THE 

Owing to this great diversity in the proportion 
of these two component parts of the blood to 
each other, the gravity, consistence, and other 
sensible qualities of this fluid, and of conse- 
quence the impressions which it is capable of 
making upon the general system, and its influ- 
ence upon the motions of the living solids, must 
be extremely various. 

The serum, when separated from the crassa- 
mentum, is apparently homogeneous, spontane- 
ously fluid, easily soluble in any quantity of 
cold water, 1 * and has the smell, taste, and feel 
of the blood, but its consistence is not so 
great, f Its specific gravity, according to Jdrin, 
is 10304 It is the lightest^ part of the blood, 
possessing less gravity than either the coagulable 
lymph, or red globules, which together compose 
the crassamentum. 

When chemically examined, the serum is dis- 
covered to be a compound fluid, consisting of a 



* Gaubius, Patholog. ^ 338. 

f Thomson, System of Chem. vol. v. p. 597. 

% Philos. Trans. No. 361. 

^ Hunter, Treatise on the Blood, &c. 



HUMAN FLUIDS. 40 

mucilaginous substance dissolved in a water thai 
holds in solution a small portion of neutral 
salts. It contains albumen, gelatin, hydro-sul- 
phuret of ammonia, soda, muriate of soda, 
phosphate of soda, and phosphate of lime.* 

In its recent and healthy state, this fluid is 
perfectly bland, and gives no evidence of a free 
or disengaged alkali; but it is rendered thin 
and acrid by putrefaction, and also acquires an 
alkalescency, as is manifest from its effervescing 
with acids.f Serum easily putrefies, but not so 
readily as the crassamentum,J and when once 
rendered putrid, it cannot, by any art, be inspis- 
sated $ although in the recent state it is easily 
coagulable by acids, by oxides, and by alcohol.jj 
As Harvey first discovered,^ it also coagulates 



* Thomson, System of Chem. vol. v. p. 598. 

f Boerhaave, Elem. Chem. torn. ii. proc. 114, 115. 

% Pringle, Diseases of the Army, Append. 

^ Haller, Elem. Physiol, torn. ii. p. 182. 

|| Dumas, Principes de Physiologie, torn. ii. p. 37. 

If De Generat Anim. 

7 



50 PATHOLOGY OF THE 

by heat ; but the temperature required for this 
purpose has, by different writers, been variously 
estimated at 148,* 150,f 156,J and 160,$ of Fah- 
renheit. By this coagulation, the serum is con- 
verted into a whitish scissile insoluble mass, not 
unlike the boiled white of an egg, and is also 
separable into two parts :|| the one a fixed, solid, 
and somewhat tenacious substance, possessing 
all the properties of coagulated albumen ;T[ the 
other, which is not coagulable by these means, 
a thin, aqueous, and almost colourless fluid, has 
been termed the serosity, and consists principally 
of gelatin.** 

The albumen, or mucilaginous part of the 
serum, after being coagulated by heat, is inca- 
pable of solution in the serosity, except by 
putrefaction, or by the addition of some chemical 
agent, and then it loses its original property 
of coagulability by heat.ff But if exposed 



* ScHWENKE. f GaUSIUS. % CuELEN. ^ HeWSON, 

|| Gaubius, Patholog. ^ 338. 

11 Thomson, System of Chem. vol. v. 

** Johnson, Animal Chem. vol. i. 

ft Hews on, Experimental Inquiries, p. 136. 



HUMAN FLUIDS. 51 

to a temperature less than that required for 
its coagulation, the serum will be gradually 
inspissated, and at length converted into a 
solid mass, which can be easily dissolved in 
water; by the addition of a due proportion of 
which, it may again be converted into serum, 
which appears to possess the same properties 
that it did before, particularly in being coagula- 
ble by heat.* The increased density or specific 
gravity of this fluid, which is said to take place 
in fever,f is to be attributed to a similar inspis- 
sation, the consequence of great heat or febrile 
excitement, which greatly dissipates the aque- 
ous and more fluxile parts of the serum ; whilst 
the more gross, viscid, and ponderous, that are 
unable to pass the constricted pores, being alone 
retained in the circulation, run into a closer 
cohesion, which necessarily augments the lentor 
and consistence of the whole mass of serum, 
and renders it less fit for diluting the other 
parts of the blood. Hence the necessity of 



* Hewson, Experimental Inquiries, p. 137. 

f Bryajs Robinson, Hauler's Elem. Physiol, torn. ii. p. 123. 



52 FATH0L0OY OF THE 

plentiful dilution in all ardent continual fevers, 
in which the serous part of the blood, as Browne 
Langrish has demonstrated from a great num- 
ber of experiments, is always much reduced 
below the proportion which it ought to bear to 
the crassamentum.* 

The crassamentum, or cruor, as it is sometimes 
called from retaining the red colour which distin- 
guishes the blood, is spontaneously solid, and 
possesses considerable density and consistence. 
Its specific gravity, according to Jurin, amounts 
to about 1128.f This substance, it is well 
known, consists of two distinct parts, namely, 
red particles and coagulable lymph, which ap- 
pear to be partially separated by a spontaneous 
action, but may be entirely so, by washing the 
crassamentum in water. 

The coagulable lymph, or as it is by some called 
the gluten, and by others, with more propriety, 
termed the Jlbrous matter of the blood, is a sub- 
stance spontaneously solid, having the greatest 



* Modern Theory and Practice. 
f Philos. Trans. No. S61. 



HUMAN FLUIDS. 53 

tendency to become concrete of all the circu- 
lating fluids; and when once coagulated, it is 
insoluble in water and alcohol, but is readily 
dissolved by the acids, and even by vinegar.* 

It is this fibrous matter which imparts to the 
sanguineous mass its plastic lentor and tenacity, 
gives solidity and firmness to the crassamentum, 
and is the true cause of the spontaneous coagu- 
lation of the blood ; for when deprived of this 
matter, it is incapable of concretion, a circum- 
stance not unknown to the ancients.f 

The specific gravity of the coagulable lymph 
is greater than that of the serum, but less than 
that of the red globules. J It putrefies with 
considerable facility $ and possesses all the pro- 
perties of Jibrin.\\ This fibrous part of the blood, 
when thoroughly freed from the red globules or 
colouring matter, is perfectly tasteless, and of a 
white colour, exhibiting a membranous texture, 



* Johnson, Animal Chem. vol. 1. 

f Vide Aristotle, De Hist. Anim. Lib. iii. Cap. 19. 

% Hunter, Treatise on the Blood, fcc. 

^ Pringle, Diseases of the Army, Append. 

|| Thomson, System of Chem, vol. v. p. 599, 



54 PATHOLOGY OF THE 

consisting of extensible and elastic filaments 
much of the nature and resemblance of muscu- 
lar fibre,* which has caused a celebrated physi- 
cian to assert, " caro nihil aliud est quam sanguis 
concretus."f It is, in reality, more highly 
animalized than the serum, and, according to 
modern physiologists, constitutes the elementary 
principle or substance of the muscles.J It ap- 
pears to be prepared by the very act of circula- 
tion to concur in the growth, nourishment, and 
augmentation of the parts of the human body. 
Like the red globules, it would seem to be con- 
nected with strength. Its quantity is increas- 
ed in inflammatory complaints,^ but is dimi- 
nished from debility, from dropsies, and also in 
putrid fevers, in which it appears to participate 
in the affection so evidently induced on the mus- 
cular organs.|| Like the serum, it is readily 



* Richerand, Elements of Physiology ; Gaubius, Pathol. 
^340. 

f Zaccheus, Quest. Med. Legal, p. 239. 

X Dumas, Principes de Physiologie, torn. ii. p. S6. 

^ Browne Langrish, Modern Theory and Practice. 

t) Richerand, Elements of Physiology, p. 177, 178, &e.. 



HUMAN FLUIDS. 55 

coagulable by heat, which, according to the ob- 
servations of Hewson,* takes place between one 
hundred and fourteen and one hundred and 
twenty and a half of Fahrenheit ; a temperature 
but a few degrees removed above that of an 
acute inflammatory fever. 

In inflammatory diseases, the coagulable lymph 
is partly separated in the blood, and covers the 
crassamentum in form of a white or yellowish 
tough crust, commonly called the huffy coat, or 
inflammatory size. This remarkable appearance, 
so frequently met with in acute disorders, ap- 
pears, among all the products of the blood, to 
have been one of those which has principally 
fixed the attention of physicians. Various opi- 
nions have prevailed with respect to its nature, 
origin, and composition. But the perfect ana- 
logy which it bears to the fibrous matter can 
leave no doubt as to its nature. 

Formerly, when inflammations were supposed 
to take their rise from lentor and obstruction, the 
buffy coat was deemed a certain proof that the 

* Experimental Inquiries, p. 82. 



56 PATHOLOGY OF THE 

blood was in a state of too great viscidity, which 
both rendered its circulation through the vessels 
proportionably more difficult, and increased its 
disposition to coagulability. But an ingenious 
modern physiologist* accounts for the formation 
of the buff on principles diametrically opposite, 
alleging that notwithstanding the apparent visci- 
dity of the blood, after it is drawn and suffered 
to cool, yet while circulating through the vessels, 
or immediately on escaping from the body, it is in 
reality more fluid than in the ordinary state pre- 
vious to a true inflammation, the action of which 
consists in an increased fluidity and a lessened 
coagulability of the sanguineous mass, and parti- 
cularly of the coagulable lymph; for "when 
the arteries are acting strongly, whether the 
whole habit be strong or not, the coagulable 
lymph is more fluid, and longer in coagulating; 
of consequence it lets the red particles, which 
are the heaviest part of the blood, fall down 
toward the bottom before it coagulates : and 
upon the spontaneous separation of the crassa- 



* Hews on, Experimental Inquiries, 



HUMAN FLUIDS. 57 

mentum is divided into two parts; the upper, 
consisting of the coagulum of the coagulable 
lymph alone, (which in this case is termed the 
buff,) the under, consisting partly of this, and 
partly of the red globules.* According, how- 
ever, to the observations of De Haenj and others, 
the phlogistic crust is not always present in a 
true inflammation, and it exists sometimes where 
there is not the smallest sign of inflammatory 
action. ShebbeareJ remarks that he has often 
observed this siziness attend the blood of persons 
in full health and vigour, where not the least 
symptom of disease had taken place, or was 
consequent of this appearance. This morbid 
aspect of the blood, then, is not of that formi- 
dable nature, or of that destructive consequence 
to health, which many have apprehended; neither 
is it a certain sign of inflammation, much less 
can its occurrence alone, on all occasions, indi- 
cate or determine the repeated use of the lancet ; 



* Fordyce, Elements of the Practice of Physic, 
f Ratio Medendi, p. 36, 37, Sic. 
$ Practice of Physic, vol. ii. p. 39. 



8 



5g FATHOLOGY OF THE 

for not to mention pregnancy, in which the ap- 
pearance is almost constant,* there are other 
circumstances under which such evacuation 
would be improper notwithstanding the presence 
of the buff: nor is it the only call for venesec- 
tion; there are several morbid conditions of blood 
indicative of an equal or perhaps higher grade 
of disease, and of a more vehement call for the 
use of the lancet. This buff has been observed in 
the last stage of yellow feveiyf- and De HaenJ 
lias seen it as late as the twelfth day of a putrid 
or petechial fever. These facts clearly show 
that it would be improper to determine from the 
presence of the size alone, when venesection 
should be repeated ; and yet have there been not 
a few who have erroneously inclined to draw 
such a conclusion. 

It yet remains to consider the red particles, or 
sanguineous globules, as they are sometimes called, 
which are ascertained to be distinct bodies pos- 

* DeHaen, Ratio Medendi,p. 39. 

f Hosack, MS. Notes on the Theory and Practice of Phy- 
sic. 
% Ratio Medendi, p. 342. 



HUMAN FLUIDS. 59 

sessing form and colour; but such is their extreme 
tenuity, that it is only through the medium of 
the microscope that they can be seen and ex- 
amined ; by the aid of which instrument they 
were first discovered in the year 1673 by the 
celebrated Leeuwenhoeck.* The doctrine* 
taught by the learned Boerhaave, that the 
blood was a fluid consisting of globules of differ- 
ent magnitudes, decreasing in regular series* 
and which he appears to have embraced on the 
authority of Leeuwenhoeck, who imagined that 
he observed, with the aid of his glasses, that six 
serous globules, which, when separate, were of a 
yellow colour, combined together to form one 
red globule, is now pretty generally exploded. 

These globular bodies are highly soluble in 
pure water, but in the serum of the blood they 
are wholly insoluble, being merely diffused or 
suspended in this fluid, and not chemically dis- 
solved ; and it is by means of this vehicle, too^ 
that they are rendered movable through the 



* Halx.ee, Elem. Physiol, torn. ii. p. 51. 



60 PATHOLOGY OF THE 

vessels ; for, of themselves, they appear incapa- 
ble of constituting a fluxile mass. The colour, 
which they impart to the blood, varies in inten- 
sity according to the different state of weakness 
or strength, of disease or health, and is of a 
lighter or darker shade as derived from arteries 
or veins. In health and vigour, the blood is 
generally of a bright and lively red ; but is more 
pale in dropsies, and in subjects of weak or 
enfeebled constitutions ; and, in general, in pro- 
portion to the depth of its tint will be its densi- 
ty, consistence, saltness, and odour. 5 * In judging 
of the state or qualities of the blood, therefore, 
Celsds very properly recommends an attention 
to its colour as well as to its other habitudes.f 

Physiologists have not, perhaps, as yet, clearly 
ascertained the several uses to which the glo- 
bules are subservient in the economy ; they ap- 



* Richerand, Elements of Physiology. 

f E vena cum sanguis erumpit, colorem ejus habitumque 
oportet attendere. Nam si is crassus et niger est, vitiosus est ; 
ideoque utiliter effunditur : si rubet et pellucet, integer est ; 
eaque niissio sanguinis adeo non prodest, ut etiam noceat, pro- 
tinusque is supprimendus est. Celsus, lib. iL cap. 10. 



HUMAN FLUIDS. 61 

pear, however, to be connected with strength, 
and to be necessary to the due excitement of the 
heart and arteries. We have already shown,* 
that the blood is the natural stimulus, the pre- 
sence of which determines the contractions of 
the heart ; and though it may be supposed that 
all the parts of the blood contribute to this end, 
yet doth it appear probable that this property is 
more especially inherent in the sanguineous 
globules, which, from being the most dense and 
ponderous part of the blood, are necessarily 
more eminently calculated for impressing and 
receiving the force of the heart, and also for 
keeping up its vibrations, as well as those of the 
arteries.f Hence it is easy to understand why 
the generation of heat should be said to be the 
principal use of the globular part of the blood ; 
and that its quantity should be found propor- 

* See p. £4, 25. 

f Nempe eadem semper vi cordis posita, momentum san- 
guinis cum ejus densitate crescit. Creditum est, etiam cor 
melius a densiori sanguine stimulari, cum procul dubio fibne 
cordis interna? profundius a ponderosiori sanguine emoveantur, 
et canis dispereat, quando ab impulsa aqua sanguis nunc valde 
diluitur. Haller, Ehm. Physiol, torn, i\. p. 149. 



62 PATHOLOGY OF THE 

donate to the natural temperature of the blood.* 
An exuberance of globules, therefore, by too 
much increasing the density and gravity of the 
blood, causes a higher action of all the vital 
motions, an augmentation of heat, and what is 
a necessary consequence of these, a phlogistic 
diathesis of body, or a strong predisposition to 
inflammatory complaints, or all diseases of in- 
creased circulation and temperature. It is in 
blood of this character, too, that the semina of 
contagious diseases find a more powerful pabu- 
lum, f 

Agreeable to the laws of dynamics, the glo- 
bules in receiving the common impulse from the 
heart, on account of their greater density, neces- 
sarily acquire a greater impetus, and are thus 
rendered efficacious, not only in propelling or 
setting in motion the inferior order of humours, 
but moreover by their vibrations and concus- 
sions they are almost as essential for digesting 
and farther attenuating the humours as the elas- 
tic fibres and vessels themselves ; so that when, 



* Hallek, First Lines, ^ 152. 

f Vide Walkef. on the Small Pox. 



HUMAN FLUIDS* 63 

in consequence of frequent bleedings, hemor- 
rhages, or other causes, the blood is too much 
exhausted of its globules, and degenerates from 
its red and dense nature into an impoverished 
or serous state, the requisite digestion of the 
chyle in the blood will no longer be completed ; 
the heart and blood vessels, from a want of due 
stimulation, have their motions impaired, the 
necessary generation of animal heat is prevent- 
ed, and all the vital powers suffer a correspond- 
ing declension.* 

The stability or permanence and strength of 
the body, therefore, depend upon a due propor- 
tion of the sanguineous globules; and health 
itself, which supposes a proper degree of den- 
sity and consistence in the circulating fluid, can 
neither subsist without the thicker parts of the 
blood, or what is usually called the crassamen- 
turn, and a diminution of its quantity causes a 
stagnation in all the smaller vessels, with univer- 
sal paleness, coldness, and debility : nor can the 
functions of life and health be maintained with- 

* Boerhaave, Instit. Med. ; Haller, First Lines, 



64 PATHOLOGY OF THE 

out the serum or fluids of the inferior orders, 
since the crassamentum, deprived of its aqueous 
portion, concretes and obstructs the straits of 
the vessels, impedes the cutaneous perspiration, 
and produces too great heat and excitement.* 

We have now given a short and general 
analysis of the blood. We have seen that the 
sanguineous mass, or that portion of our fluids, 
which fills and flows in the red vessels, and is the 
reservoir or common source from which all the 
other humours seem to be derived, is, every- 
where, a heterogeneous aggregate, consisting 
chiefly and especially of four distinct parts : to 
wit, albumen, serosity, coagulable lymph, and red 
globules, in one or the other of which are con- 
tained all the ingredients naturally belonging to 
the blood. When separately examined, these 
several parts are found, in most of their qualities 
and accidents, to be very distinct; some being 
more dense, ponderous, and cohesive, or more 
easily putrescent than others ; some of a nature 
approaching to solidity, and others more tenuous 

* Haller, First Lines, ^ 154, 



HUMAN FLUIDS. 65 

and fluxile ; but when intimately intermixed or 
combined in the form of blood, these several 
parts mutually temper, or qualify each other, 
and constitute an entirely new and apparently 
homogeneous mass, of a uniform density, con- 
sistence, and fluidity throughout; which qualities 
of the aggregate, however, must vary with the 
different proportions of the proximate ingredients 
which constitute it as a whole. Nor, indeed, 
would it appear competent to the integrity of the 
functions, that these parts should be united in 
any proportions indifferently. The blood, to 
possess a perfectly healthy texture and consist- 
ence, adapted to all the purposes for which it is 
designed, would seem to require a certain mutual 
proportion; any considerable deviations from 
which must so affect the powers and qualities of 
the mass, as to render it less fit for the well being 
of the economy.* " Nor are the proportions of 
the elements, which we have hitherto mentioned, 



* Verosimile est dari certam aliquam trium sanguinis partium 
proportionem mutuam, quag sanitati perfects maxirae conveniat. 
Gaubius, Patholog. *j 353. 

9 



QQ PATHOLOGY OF THE 

constant : for an active life, manhood, and lever, 
increase the cruor, redness, coagulability, cohe- 
sion of the parts, firmness of the coagulated 
serum, weight, and alkaline principles. The 
serum, and the mucus it contains, are increased 
by the contrary causes ; a less mature age, inac- 
tive life, and a watery and vegetable diet ; by 
all which, the crassamentum of the blood is les- 
sened, and its watery part increased. Old age 
again augments the cruor, and diminishes the 
gelatinous part."* 

We have seen, too, that in combination with 
the insensible particles of the blood, are sul- 
phureous, oleaginous, and different saline mate- 
rials both fixed and volatile, which, in a proper 
quantity, appear essential toward maintaining a 
natural and healthy eras is ; and so long as they 
hold their natural combinations, they are devest- 
ed of all noxious qualities : but when, from any 
cause, these acrid substances are too copiously 
evolved, exalted, and rendered volatile, they 
must necessarily become sharp, acrid, and corro- 

* Haller, First Lines, q 150, 



HUMAN FLUIDS. 67 

sive, and thereby, more or less, introduce a 
noxious acrimonious quality, which will be ca- 
pable of still further vitiating the crasis of the 
blood, of irritating the solids, and weakening 
and destroying the vital powers. The occur- 
rence of a spontaneous and noxious acrimony, 
however, is not very common, which, indeed, is 
ascribable to the constant and easy egress from 
the system, by the urinary passages and pores of 
the skin ; through which media, the degenerating 
and degenerated parts of the blood are elimi- 
nated, or thrown out from the circulation. 

From all that has been said, then, upon the 
nature of the blood ; from a due considera- 
tion of its heterogeneity, the various parts of 
which it is compounded, and their various 
qualities or accidents, the diversity of their 
composition and properties, and the differ- 
ence of the causes by which they are severally 
influenced, it is easy to understand that the sen- 
sible and chemical qualities of this fluid may 5 
under different circumstances, be variously af- 
fected. For though mankind might, in the strict- 
est sense of the word, be said to be of one blood. 



6H PATHOLOGY OF THE 

yet different climates, seasons, modes of living, 
air, exercise, indolence, luxury, intemperance, 
different aliments, want of common necessaries, 
or the continued use of such as are of a vitiated 
quality, the intervention of disease, and a variety 
of other causes, cannot fail, sooner or later, to 
affect the constitution, or to influence and diver- 
sify the nature, powers, and sensible qualities of 
this one animal fluid. 

Having given a general view of the nature of 
the blood, of the effects which chemical agents 
have upon it, of its spontaneous separation into 
its proximate component parts, and of their 
various properties, it will be proper, in the next 
place, to trace the outlines of its vitiations, 
taking them in the order before mentioned. 



Morbid Fluidity of the Blood. 

Fluidity is that property of bodies, by which 
their parts, being very fine and small, are so dis- 
posed by motion and figure, as readily to yield 



HUMAN FLUIDS. 69 

to any force impressed, and to be easily moved 
among one another in all manner of directions. 
In this respect, fluidity stands opposed to solidity, 
whose essential character is stability and firm- 
ness. All fluids differ from solids, but they 
differ only in the cohesion of matter, which the 
former in some measure possess, although small 
in degree ; for cohesion entirely destro} 7 ed takes 
away the idea of a fluid as well as of a solid ; so, 
on the contrary, when it is increased, it changes a 
fluid into a solid. The blood is called a fluid, be- 
cause, while circulating through the vessels, and 
under the control of the vital principle, it is always 
found in a fluxile state ; a property essential to 
its offices or functions; for, without this form, 
it would be incapable of a circulatory motion, 
or of being propelled through the flexile tubes, 
distributed to all parts of the living engine, and 
again returned to the heart. It could not be 
divided into different portions, as the vessels 
branch off, nor could it pass through the straits 
of the vessels, and admit of the various separa- 
tion of its parts that are intended for the aug- 
mentation and repair of the whole body; nei- 



70 PATHOLOGY OF THE 

ther could it be adapted for furnishing the differ- 
ent secretions and excretions. 

The most simple affection of the blood, there- 
fore, is that which has for its foundation a change 
in the state of the natural cohesion, or fluidity. 
A knowledge of the conditions upon which the 
fluidity of the blood depends, will point out the 
nature of its vitiations. 

The force of cohesion, when natural, is not the 
same among all the parts of the blood ; each has 
its own degree by which it is fitted for the uses 
required ; and this cohesion being increased or 
diminished, fluidity will be proportionably so. 
The blood, when examined by the senses, as we 
have before shown, is found to be composed of 
different matters, in part fluid, another part 
being solid. The crassamentum, which by itself 
is spontaneously solid, owes its fluidity to an 
interfluent vehicle, by which its parts are dilu- 
ted, separated, and adapted for a circulatory 
motion through the vessels. The varied propor- 
tion of the one to the other of these parts, 
therefore, will constitute different degrees of 
fluidity in the mass of blood 5 and vary the con- 



HUMAN FLUIDS. 71 

sistence. Nor is the proportion between the 
quantities of serum and crassamentum so fixed 
as might, perhaps, be apprehended. Haller 
observes, " In massa sanguinea media pars, et 
ultra, cruoris est : in robore valido serum min- 
uitur ad tertiam partem ; in febre ad quartam et 
quintam reducitur ; in morbis a debilitate incre- 
scit."^ The gravity, consistence, and fluidity 
of the blood, therefore, will be equally various. 

A redundancy of serum, which also increases 
the proportion of water in the blood, by too much 
diluting and attenuating the crassamentum, is 
productive of an aqueous tenuity of the whole 
mass of circulating fluids, and of the diseases 
occasioned by serous congestions, or by a want 
of due motion and heat. 

An exuberance of crassamentum, on the con- 
trary, or in other words, a paucity of serum, by 
admitting a nearer approximation, and more 
close and obstinate attraction between the gross 
and viscid parts of the blood, so as to favour 
their union into larger and more dense particles^ 

* Primse Linese Physiologic, ^ 138. 



72 PATHOLOGY OF THE 

is productive of a preternatural spissitude and 
viscidity of the whole sanguineous mass, or at 
least of such a glutinous adhesiveness of its 
parts, as impedes or prevents its free and equa- 
ble circulation through the different orders of 
vessels. 

The fluidity of the blood, then, may be faulty, 
or preternaturally affected in two ways, either 
by an excess or defect of fluidity ; the former 
vitiation is denominated tenuity and resolution; 
the latter spissitude and viscidity. 

Tenuity of the humours, which indicates an 
excess of fluidity, is of different kinds. The first 
and most simple species may be called the 
aqueous, which is caused by a redundance of 
serum, or water, in the humours, by which inter- 
fluent medium, the other constituent parts of the 
blood are too much separated, and the globular 
part being diffused into too small particles, too 
loosely cohering, are attenuated, and the whole 
mass of humours becomes preternaturally thin 
and fluxile.* 



* Gaubius, Patholog. ^ 237. 



HUMAN FLUIDS. 73 

This state of the humours arises from the ex- 
ternal and internal abuse of watery things ; a 
scanty, or a little nutritious diet; depraved 
concoction in the stomach, lungs, and other 
viscera; torpor and debility of the heart and 
blood vessels ; a sedentary, inactive life, espe- 
cially in a moist atmosphere; suppression of 
the usual watery excrements by the pores of 
the skin, and by the urinary passages, either from 
cold, or from some vice in the organs them- 
selves ; too copious and frequent evacuations of 
blood, which unbends the force of the heart and 
vessels, produces a languid circulation, diminu- 
tion of vital heat, and a consequent retention of 
the usual watery excretions.* 

The consequences of this thin and impove* 
rished state of the blood, are want of due ex- 
citement in the heart and arteries ; torpor of all 
the functions; defective heat and nourishment; 
and the solids themselves, by being, as it were* 
perpetually macerated in watery humours, lose 



* Vide Gregort, Conspectus Medicinse, ^ 520. ; Gaubius, 
loc. cit. 

10 



74 PATHOLOGY OP THE 

iheir natural elasticity, and become weak and 
flaccid ; whence a languid circulation, coldness, 
universal paleness, debility, cachexy, serous 
congestions, hydropical effusions, Src. 

Some physicians have maintained, that our 
fluids could not possibly offend by too great a 
tenuity ; since thin juices pass with least impe- 
diment through the capillary vessels ; whence, 
it was supposed, " that this condition of the hu- 
mours must be productive of the openest and 
readiest circulation of them." Such person* 
do not appear to have rightly considered the 
healthy nature of our fluids ; for the blood of a 
strong and healthy subject, as we have before 
remarked, is a fluid of considerable density and 
thickness, by which, when withdrawn from the 
vessels, it is disposed immediately to run into a 
solid cohesive mass; whereas, the blood, in 
weak and valetudinary subjects, has not such 
firmness of texture ; but is much thinner, and 
less easily disposed to a solid cohesion. From a 
consideration of this one single fact, they might 
have easily perceived, that the occurrence of a 
too thin state of the humours would render a 



HUMAN 1'LUIDS. 75 

strong and healthy person in the condition of 
one who is weak and valetudinary. Moreover, 
since the red part of the blood, (which by the 
largeness of its globules is confined within the 
larger arteries and veins, and hinders them from 
collapsing,) in receiving the common impulse 
from the heart, by reason of the greater density 
of its parts, necessarily acquires a greater im- 
petus or motion, which it communicates to the 
other humours, and assists in propelling them 
through the inferior order of vessels ; and as the 
heart itself is more duly excited by the ponder- 
ous globules ; therefore, when the blood becomes 
too thin and watery, or is deprived of its due 
proportion of globules, the action of the heart 
and arteries is impaired, the motion of the blood 
weakened, and the heat of the body proportion- 
ably lessened. Whence the watery liquors will 
not be easily exhaled from the body, but remain 
therein, and distend the vessels so as to give 
rise to serous congestions, or to be effused into 
the different cavities of the body, and thus pro- 
duce a cachexy or dropsy. It is evident, there- 
fore, that the animal humours may offend by a 



76 PATHOLOGY OF THE 

too watery state, or by becoming preternaturally 
tenuous.* 

The other species of morbid tenuity, which is 
indicative of a dissolved state of the blood, 
arises from want of a due pressure of the hu- 
mours by the vital and elastic force of the vessels 
and viscera ; or it is of a compound nature, having 
an acrimony joined with the humours, by the 
attenuating power of which the globules and 
coagulable lymph are dissolved and broken 
down, and the crasis of the whole mass of blood 
so much injured as to prevent the mutual and 
necessary coherence of its parts.f 

Hewson has demonstrated, by some ingenious 
experiments, that the coagulable lymph of the 
blood may be so much attenuated as to dilute 
even the serum itself.J This dissolution of the 
animal fluids takes place from an acrimony 
varying greatly in its nature, either from the 
native oils and salts, resident in the body, being 
too much in quantity, or too largely evolved 

* Vide Van Swieten, Commentar. ^ 1174, &tc. 

f Vide Gaubius, Patholog. ^ 288. ; Van Swieten, he. cit. 

i Experimental Inquiries, Exp. xviii. p. 49. 



HUMAN FLUIDS. 77 

or corrupted ; or from some extraneous accession 
from meat, drink, medicines, poisons, miasmata, 
contagions.* 

A resolution of the red particles, and an at- 
tenuation of the coagulable lymph, says a late 
celebrated physician, are effects which fre- 
quently occur in the system, though in different 
degrees. It is a temperament natural to some 
families ; and, when it is hereditary, may be 
greatly increased by external causes ; and even 
these causes of themselves are sufficient to 
induce the habit: such as a course of close, 
sultry weather ; a continued application of warm 
humid air to the body; animal steams, where 
many persons are crowded together in small ill- 
ventilated apartments; putrid exhalations; the 
air of an hospital, where putrid ulcers, dysente- 
ries, &c. prevail.f 

This dissolved state of the blood is equiva- 
lent to what is denominated, by many eminent 
authors, the putrid diathesis; and forms a habit 



* Gaubius, loc. tit. 

f Walker, An Inquiry into the Small Pox, p. 120, 121. 



78 PATHOLOGY OF THE 

of body extremely obnoxious to low, nervous, 
putrid fevers, and to the operation of contagious 
virus. 

The general indications of this morbid tem- 
perament are, paleness of complexion, soft and 
relaxed fibres, aversion to motion, fatigue from 
the smallest exertions : persons of this constitu- 
tion, too, are, on many occasions, liable to faint.* 

Another vitiation of fluidity, to wit, a preter- 
natural spissitude, or too great a viscidity, or 
thickness in the consistence of the blood, is a 
constitution or crasis directly opposite to tenuity, 
and supposes a deficiency of fluidity, which is 
no less various, and must be explained in order, 
according to its differences. If the thickness, or 
cohesion of the humours, arises from an excess 
of animal motion, or from a too violent circula- 
tion and great strength of vessels, it is then 
called an inflammatory spissitude, or more pro- 
perly a phlogistic disposition of the humours : 
but when, from a defect of the animal motions, 
or from too languid a circulation, and weakness 



Walker, An Inquiry into the Small Pox, p. 122. 



HUMAN FLUIDS. 79 

of the vessels and viscera ; from a loss of the 
fluids ; or from feeding too plentifully upon such 
substances and kinds of aliments, as are of a 
glutinous and tenacious quality, or in themselves 
apt to run into such cohesions as cannot be 
easily separated by the vital powers, it has been 
then denominated a glutinous or viscid lentor ; 
which is productive of that white swelling, or 
turgescence of body, that the ancient physicians 
have called the leucophlegmacy, (^uKop^^aT/*,) or 
white phlegm.* 

In the latter vitiation, the blood is so far de^e- 
nerated as to lose both its natural redness and 
density, to grow lighter, become more lax, and 
acquire almost a mucous nature. In this state 
of the blood, the coagulable lymph is not suffi- 
ciently participant of an animal nature ; the red 
globules are too few in number, and those too 
loosely compacted; and the serum is more 
viscid or ropy than ordinary. In a word, the 
whole sanguineous mass becomes too gross, 



* Vide Van Swietejv, Commentar. ^ 69 to 76. fy 1174, 



gO PATHOLOGY OF THE 

viscous, and inactive : and when, in this morbid 
state, the circulating fluid has been imprudently 
withdrawn from the vessels, a very little red con- 
crete blood is found swimming in a large quan- 
tity of viscid glutinous serum.* 

The phlogistic constitution of the blood, on 
the contrary, indicates a deficiency of serum, or 
rather a superabundance of crassamentum, which 
necessarily increases the density, firmness, and 
consistency of the whole mass of blood. The 
red globules are in too great quantity, and too 
closely compacted or condensed ; the coagulable 
lymph is more highly animalized, and the serum 
more dense than ordinary ; and thus the whole 
mass of blood, being rendered too dense and 
ponderous, is, in virtue thereof, proportionably 
more exciting to the heart and arteries, and, of 
consequence, is productive of a too active and 
vigorous circulation. This morbid quality is, 
sometimes, very evident to the senses, where the 
blood that is taken from some persons has very 



* Van Swieten, Commentar. ^ 72. 



HUMAN FLUIDS. 81 

little serum separated from the coagulum, though 
it has stood a sufficient time for such separation : 
thus it commonly is in acute inflammatory or 
ardent fevers, and likewise in the beginning of 
some eruptive fevers.* It also appears, from the 
experiments of Browne Languish,! that the 
blood is more thick, dense, and tenacious, or at 
least that the crassamentum abounds more, and 
the serum less in quotidians than in tertians, and 
in tertians than in quartans ; and in all these the 
red globules bear a greater proportion than is 
consistent with health ; but in quotidians, ceteris 
paribus, the blood comes nearest to an inflam- 
matory state. Now, when the sanguineous glo- 
bules are in great number and very dense, and 
the vessels themselves strong and elastic, a 
greater momentum of motion must be produced 
in the circulating fluids, and, of consequence, 
much heat, which both dissipates the more subtle 
and watery parts of the blood, and incrassates 



* Vide Lobb, Practice of Physic, vol. i. lect. 3. ; Browne 
Languish, Modern Theory and Practice, 
f Ut antea, chap. v. 

11 



82 PATHOLOGY OF THE 

the remainder, so that it becomes more firm and 
cohesive, and less fit to circulate through the 
minima vascula, or extreme capillary vessels. 

The red particles and coagulable lymph have 
been justly considered, by physiologists, as the 
most active or inflammatory parts of the blood ; 
and this quality they appear to derive princi- 
pally from their greater density or weight, by 
which the action of the heart and arteries is 
more duly excited ; and of consequence there 
is produced a greater impetus of the circulating 
fluids, with a proportionate augmentation of 
temperature ; for whatever be the cause of the 
natural or vital heat, nothing is more plain, than 
that its increase and decrease are always, ceteris 
paribus, as the different velocities or projectile 
force of the blood. We may observe, that all 
persons readily have their temperature increased 
by labour, or exercise, which augments the mo- 
tions of the blood; but persons in health, who 
have a due quantity of red particles in their 
blood, are sooner heated by exercise, than those 
who are infirm, and have a poor blood, or few 
sanguineous globules. And, indeed, in proper- 



HUMAN FLUIDS. 83 

tion to the crassamentum in the blood, is the de- 
gree of heat in all animals. The experiments of 
Shebbeare demonstrate, that all animals, whose 
degree of heat is superior to the human, have a 
larger proportion of crassamentum in their 
blood, than mankind in health.* Is it not pro- 
bable, therefore, that different proportions of 
red globules in the blood of persons in health 
may have some share in producing a difference 
of temperament ? 

The signs of an inflammatory diathesis of the 
blood, are great strength of the fibres, a strong, 
firm pulse, much heat, and redness that is parti- 
cularly observable in those places where the 
tender vessels are not covered with true skin ; 
as in the lips, the gums, the tongue, the inside of 
the mouth, the nares, the corners of the eyes, 
the adnata, the inside of the eyelids, fyc. But 
when the glutinous or viscid lentor predominates 
in the humours, there is paleness in all these 
parts; a weak and languid circulation, w 7 ith 
coldness, sluggishness, and a laxity or doughy 

• * Shebeearf, Practice of Physic, vol. i. p. 248. 



84 PATHOLOGY OF THE 

softness and intumescence of the whole body. 
Hence, in the beginning of a leucophlegtnatic 
habit, persons, observing themselves grow more 
full and bloated, are deceived by this specious 
appearance, and are often pleased to think they 
are perfectly well, and growing fat. 

In general, persons of vigorous, robust con- 
stitutions, of strong, rigid fibres, who take much 
exercise, and a full diet, are peculiarly subject 
to a rich, dense, inflammatory blood, which ne- 
cessarily increases the phlogistic diathesis of 
body, and renders it constantly liable to acute 
ardent fevers, and inflammations ; on the acces- 
sion of which there will be produced the most 
violent symptoms, which will quickly prove fatal 
except when prevented by timely bleeding, cool- 
ing, diluting, emollient drinks and medicines. 
The other condition of the circulating fluid, on 
the contrary, is common to persons of a relaxed 
habit of body, or those in whom the solids have 
lost their due force and elasticity ; for whenever 
this happens, the parts of the blood, being 
less agitated, cannot but thereby the more at- 
tract one another, and in this case cohere in too 



HUMAN FLUIDS. 85 

viscous a manner; nor can the action of the ves- 
sels divide the juices so minutely as is required 
for their circulating through the very small pas- 
sages of the minima vascula or capillary vessels. 
From the viscid or slimy lentor, therefore, ob- 
structing the small vessels, and preventing the 
due motion of the humours through them, there 
necessarily follows an imperfect or disordered 
state of all the concoctions, circulations, secre- 
tions, excretions, and all the vital, natural, and 
animal motions,* Hence, universal indigestion, 
weakness, coldness, paleness, cacoehymy, leuco- 
phlegmatic and dropsical disorders, glandular 
obstructions, and fevers of the low and slow 
nervous kind. In this state, too, the blood having 
lost its most vital principles, and at the same 
time being too slowly moved, at length, for want 
of due motion and circulation, falls into a spon- 
taneous corruption, productive, at last, of such 
a degree of acrimony or putrescency, as not only 
to corrode and destroy the contexture of the 



Boerhaave, Aphor. de cognosc. et curand. Morbis, 72, 



86 PATHOLOGY OF THE 

more delicate solids, but sometimes to end in 
fevers of a dangerous, putrid, malignant na- 
ture.* 

It will appear from what has already been 
said, that these two different states of the fluids 
may not improperly, to a certain degree, be con- 
sidered as constitutional, for they naturally fol- 
low the respective state of the solids ; so that a 
strong, rich, inflammatory blood always attends a 
strong, elastic set of vessels ; and a gross, viscous, 
or weak blood, a relaxed habit of body, or a 
weak state of the vessels and viscera ; but where 
either considerably deviates from the standard 
of nature, it becomes a real vitiation, and, as 
such, is to be duly regarded in the treatment of 
any concurring disease. 

As the several states or conditions of blood, 
which have now been described, may arise from 
various causes, and be also complicated with dif- 
ferent habits of body, it is obvious that, as it re- 
spects their curative indication, nothing in gene- 
ral can be here determined ; but we must care- 



* Vide Huxham, Essay on Fevers. 



HUMAN FLUIDS. 87 

fully endeavour to ascertain the nature of the 
morbid quality in the humours, and also the 
cause from which it proceeds, a right apprehen- 
sion of which frequently leads to the proper 
correction.* For example, if the humours are 
too thin and aqueous, from an abuse of watery 
things, the cure will be effected by a dry regi- 
men and diet, and by giving strength to the over- 
relaxed vessels; but if they are dissolved by 
acrimony, or some contagious miasmata, the 
indication is to correct and weaken the same by 
plenty of watery and emollient drinks. Again, 
where there is an inflammatory disposition of 
the blood, the vessels are to be relaxed, that they 
may the less compress their contained humours; 
but when a viscid lentor and thickness prevail, 
the strength of the vessels is to be increased, 
that they may the more duly actuate the con- 
tained humours, and work them up to a healthy 
texture and consistence.! 



* Et causae quoque estimatio sa^pe morbum solvit. Ceisus* 
In Prmfat, lib. i. p. 16. 
i Van Swietei*, Commentar. ^ 1174. 



§3 PATHOLOGY OF THE 

Physicians have described another vitiation of 
fluidity, in which the blood is supposed to lose 
its natural mildness and fluxility, and to grow 
preternaturally thick, black, and viscid ; so as to 
be less fit for its different motions, and the uses 
of life. It consists, therefore, in both a morbid 
spissitude and viscidity. Now the ancients, as 
may be learned in Aret^us,^ actually observed 
such a degeneration of the blood in melancholic 
persons; which is, likewise, confirmed by the 
observations of modern physicians.f 

The causes of this morbid quality of the blood 
and humours, may be every thing that expels the 
watery and more moveable parts of our juices, 
and has a tendency to fix the rest : of conse- 
quence, it has for its matter the thick oil and earth, 
or the more gross and more tenacious parts of the 
blood united and compacted together.^ 

Now if the entire mass of blood be in any way 
exhausted of its succulent, and more moveable 



* De Curat Morb. Diutura. lib. i. cap. 5. 
f Vide Hoffman, Medicin. Rational. System, torn. iv. p. 201 ; 
Mead, Medical Works, p. 372. 424. 
X Boerhaave, Aphor. 1093. 1095. 



HUMAN FLUIDS. 89 

parts, it necessarily follows, that the thick and 
less fluxile will then be left in closer cohesion ; 
whereupon, the common circulating mass, 
despoiled of its limpid vehicle, assumes a more 
tenacious and immovable disposition, by which 
its circulation through the smaller vessels will be 
rendered more difficult ; while, at the same time, 
the said blood itself will be less mild than natu- 
ral, or, at least, more apt to degenerate into an 
acrid state, in consequence of any given quan- 
tity thereof containing proportionably a greater 
stock of animal salts and oils. 

The refinement of modern investigators has 
added to the consideration of the animal fluids 
a new source of disease, supposed to be connect- 
ed with those changes which depend on the 
composition of our fluids ; that is, their relation 
with different proportions of oxygen, nitrogen, 
carbon, and hydrogen. But as this subject has 
not yet received, from the pathologist, a share of 
public attention, it may, in this place, be passed 
over without any further notice. 

This finishes morbid fluidity, or the considera- 
tion of those simple affections of the blood de- 

12 



90 PATHOLOGY OF THE 

pending upon some change or difference in the 
state of its natural cohesion and consistence: 
which change, it has been shown, may arise 
either from some variation in the proportion of 
the discordant parts of which the blood consists, 
or from some default in the texture of this 
fluid. 

Now, as the state of the fluids, in the body, 
appears in general to depend chiefly and espe- 
cially on that of the solids, it will, no doubt, by 
some, be urged, that to the consideration of the 
former we have attached more importance than 
they in reality merit ; it being seldom that we 
can fairly and immediately deduce morbid symp- 
toms from the state of the fluids alone. In reply 
to this, it will suffice to observe, that in describ- 
ing the various morbid constitutions of the animal 
fluids, and their effects upon the body, we have 
represented them such as they may generally be 
supposed to be in their full extent, and when influ- 
enced by circumstances favourable to their ope- 
ration : not that the same effects may not proceed 
from other causes, or in general be traced with 
more certainty to other circumstances of the con- 



HUMAN FLUIDS. 91 

stitution more fundamental, and more powerful 
in determining its condition. It was on a former 
occasion remarked, that such is the limits of 
health, that every deviation from the sound state 
is not disease ; though probably each may be 
supposed to form a predisposition to disease 
Thus with the blood itself: every deviation 
from the natural standard does not necessarily 
become an immediate cause of disease; but 
still, each may render the animal body more ob- 
noxious to the influence of morbific causes in 
general; and by concurring with the solids 
themselves, on many occasions produce disor- 
ders in the constitution, which would not other- 
wise have taken place. It is certain, ceteris 
paribus, that a poor, watery blood will produce 
effects upon the constitution different from those 
arising from an inflammatory blood, or such as 
abounds too much in red particles. This latter, 
on account of its greater density and weight, 
will more duly excite the heart and arteries, pro- 
duce a higher degree of the vital heat and mo- 
tions, and in this manner predispose the body to 
ardent and inflammatory fevers, or all diseases 



92 PATHOLOGY OF THE 

of increased circulation and heat : whereas, 
blood of the former character, from containing 
too small a quantity of red particles, or being 
less dense and ponderous than natural, will be 
less exciting to the heart, and of consequence be 
attended with a lower state of the vital heat and 
motions. The solids themselves, too, from 
being perpetually loaded with these watery hu- 
mours, will lose much of their natural cohesion 
and elasticity, and become weak and flaccid. 

To conclude : although the consideration of 
the state of the solids, or rather the conside- 
ration of the motions and moving powers of the 
animal system ought, doubtless, to form the 
leading inquiry in distinguishing the different 
states of the body both in health and sickness ; 
yet it must also be acknowledged, that the state 
and various condition of the animal fluids have 
some share in this respect ; and, of consequence, 
are not to be entirely neglected by the patho- 
logist. 



HUMAN FLUIDS. 93 



Morbid Acrimonies of the Blood, 

When we consider the fluids as they are in the 
human body when sound, says a learned writer,* 
it is evident, that they are not fitted by fluidity 
alone for answering the ends required ; but that 
other properties are requisite, and these are 
either common to all, or proper to single ones, 
by which they both differ from other liquors not 
of the human body, and from one another. 

The most common characteristic quality of our 
healthy circulating fluids is the mild or bland ; 
directly opposite to which, is the vitiation of 
acrimony, as it is called, which appears to have 
been much too frequently and too rashly accused 
as the cause of many diseases. Nature has been 
solicitously careful to guard against the admis- 
sion of such a pernicious quality in our humours ; 
for she has not only taken various precautions to 
prevent acrid materials from reaching the com- 



Gaubius, Patholog. ^ 289, 



S4 PATHOLOGY OF THE 

mon mass of blood, but further, even after 
having entered the circulation, they are fre- 
quently rendered inert by being largely diluted 
with a considerable portion of the circulating 
fluids, and probably sheathed by the mucilagin- 
ous, or albuminous portion of the blood ; or else 
by stimulating the secretory and excretory or- 
gans to a larger secretion, they are eliminated, 
before they have time to hurt, together with 
the saline, putrescent, and other degenerated 
and degenerating parts that are continually 
passing off by the several excretions. There 
are, however, some evidences of the operation 
of a morbid acrimony. The subject must there- 
fore be inquired into. 

The term acrimony, as applied to the human 
body, includes all those noxious and morbific 
matters, which, being mixed with the blood, 
either destroy its healthy crasis, stimulate the 
living solids, or corrode the inert.* 

Pathologists have divided acrids into mechan- 
ical and chemical, but in this place it will be ne- 

* Macbride, Theory and Practice of Physic, p. 85. 



HUMAN FLUIDS. 95 

cessary to consider, particularly, the latter only ; 
since it alone, as Gaubius remarks, may so in- 
fect the fluids as to constitute a part of them. 

The sources of a morbid acrimony are either 
internal, and derived from the spontaneous de- 
generation of the humours themselves ; or exter- 
nal, and situated in the perpetual intercourse 
which the living human body holds with various 
external things ; and thus the air, meat, drink 9 
condiments, medicines, poisons, miasmata, and 
contagions, may introduce different acrimonies 
into the fluids in different ways, which being 
there evolved and corrupted by heat and mo- 
tion, or excited into action by the vital power* 
induce itchings, pains, erosions, various kinds 
of eruptions, with irregularities in the animal 
motions, spasms, and many other perturbations 
of the functions. It is one of the laws of acri- 
mony to act, or become more injurious to the 
body, in proportion as it is moved. Hence scor- 
butic persons are rendered most sensible of their 
pains upon motion or exercise of any kind^ 



96 PATHOLOGY OF THE 

which accords with the well-known axiom, acria 
nulla aguntj si non movedntur.* 

The principle sources of acrimony next merit 
consideration. 

The various kinds of food or alimentary sub- 
stances, which have been accused of introducing 
an acrimony into the prima vice, and afterwards 
into the fluids, do, no doubt, many of them pro- 
duce such an effect; but there are also, proba- 
bly, many others which have little influence in 
this respect. An acid in the stomach produced 
from a vegetable diet, or the continued use of 
acids and acescent things, which cannot be sub- 
dued by the powers of the body, certainly injures 
the digestion, and produces, in consequence, 
debility ; but it perhaps rarely, if ever, enters 
so largely into the circulation as to taint the 
mass of blood. There is no trace of an acid 
in this humour, nor even in the secreted fluids, 
if we except the ureal and arthritic concretions, 
and of these, the latter only can be obscurely 
traced to a vegetable, or acescent aliment. An 



* De Gqrter, Tract de Perspir.cap.yii. ^ 5. 



HUMAN FLUIDS. 97 

acid, indeed, is foreign to the body ; for no ani- 
mal humour, properly so called, ever appears to 
become acid of itself. Should an acid acrimony, 
therefore, ever actually be discovered to take 
place in the blood, its origin would seem to 
be owing to the aliments not being sufficiently 
changed by the vital powers. 

An alkalescent diet is not frequent. The 
aliments derived from the animal kingdom, how- 
ever, approach much nearer to this character 
than those from the vegetable. 

Animal substances are almost all of an alka- 
lescent, or, perhaps, rather a putrescent nature. 
They greatly abound in salts and subtle oils. 
An excess of animal food, therefore, by convey- 
ing into the system, large quantities of saline 
and other active particles, is thought to inflame 
the juices, produce an alkaline disposition of the 
blood, and strongly incline it to putrefaction.* 



* A person that lives on nothing but mere water, and flesh or 
fish, without any thing either acid or acescent, soon contracts a 
very great rankness in all his humours ; he grows feverish, and 
at length his blood runs into a state of putrefaction. Httxhatvi, 
Dissertation on the Ulcerous Sore-Throat, p. 304. 

13 



1)8 PATHOLOGY OF THE 

The experiments of Dr. Young show the influ- 
ence of animal food in giving an alkalescency to 
the animal fluids, and also the necessity of a 
due proportion of vegetable aliment, or aces- 
cents, to correct this tendency in the humours. 
These experiments inform us, that by feeding a 
bitch on animal food alone, she " afforded a milk 
acescent and spontaneously coagulating, like 
that of ruminating animals ; whereas the same 
bitch, for a little time fed entirely with animal 
food, afforded a milk manifestly alkaline, and 
not spontaneously coagulating."* Such animals 
as feed upon other animals are well known to 
have their juices easily disposed to become alka- 
line ;f their flesh is rank and unsavoury .J AH 
those creatures which live upon prey have con- 
stantly a strong and fetid breathy 

Now a putrescency, or as Dr. Cullen ex- 
presses it, " an alkalescency, is the peculiar ten- 



* Vide Cullen, Mat. Med. vol. i. 

f Boerhaave, Aphor. 97. 

% Vide Hunter, Animal Economy. 

5> Van Swieten, Commentar. 



HUMAN FLUIDS. 9$ 

dency of the animal economy ;"* which will be 
more easily understood from a consideration of 
the nature and generation of what are called the 
animal salts ; into which is converted a consi- 
derable portion of almost every thing ingested.f 
Even the strongest vegetable acids are by the 
vital powers converted into a neutral, or a sort 
of ammoniacal salts, which, in proportion to the 
time they are exposed to the action of the vessels, 
and the heat of the body, are rendered more and 
more subtle, approach nearer and nearer to an 
alkaline nature, and would at length become 
actually alkaline, were they not diluted, washed 
off, and corrected by acescent drink and diet.J 
If the aliment, then, be chiefly of the alkalescent 
kind, as most animal substances appear to be, it 
will conspire with the action of the body, and 
of consequence greatly increase this natural 
tendency of the fluids. Experience, indeed, 
shows that no person is able long to support a 



* Materia Medica, vol. i. p. 218. 

f Gregory, Conspectus Medicinse, ^ 529. 

\ Huxham, ut supra. 



100 PATHOLOGY OF THE 

diet of flesh and fish alone, unless corrected by 
a proper proportion of vegetables, or of acids 
and acescent things. A confinement to animal 
food, with abstinence from recent vegetables, is 
generally admitted to be among the principal 
causes of scurvy. Upon the first establishment 
of the New- York State Prison, about 1797, before 
a regular system of internal management with 
regard to the diet of the house was adopted, an 
alarming scorbutic disorder made its appearance 
among the greater part of the prisoners in that 
institution. They had been confined for some 
time to a diet almost exclusively of animal pro- 
visions ; and without adverting to the source of 
the complaint with which they became affected, 
a variety of means was employed for its removal, 
but, as might have been anticipated, without 
effect. At the suggestion of Dr. Hosack, who 
shortly after this period was appointed the phy- 
sician to the establishment, the liberal use of 
recent vegetables was enjoined as indispensably 
necessary in order to check the progress of the 
disease,and for the purpose of restoring the health 
of the prisoners. The learned and experienced 



HUMAN FLUIDS. 101 

Dr. Ferriar* found that many of his diabetic 
patients were rendered scorbutic, by a strict ad- 
herence to the exclusive use of animal food. 
Instances of a similar kind have fallen under the 
notice of Dr. HosACK.f The scurvy, it is well 
known, is much more frequent, and, indeed, 
almost epidemic, in cold and northern climates, 
where, from a scarcity of vegetables, the inhabit- 
ants are obliged to live principally upon flesh 
and fish. The diet of the Icelanders, which 
consists almost exclusively of animal matter, 
is universally productive of a train of obsti- 
nate cutaneous and scorbutic affections, which 
have been lately noticed by Dr. Holland.J 
The learned Dr. Lind$ has, on this subject, 
furnished us with a very remarkable story from 
Sinop^us.II " There are whole nations in Tar- 
tary who live altogether on milk and flesh. 
These people are never seized with the small 



* Medical Histories and Reflections, vol. iv. 
f MS. Notes on the Theory and Practice of Physic, 
\ Vide Eclectic Repertory of Philadelphia, vol. iii, 
^ On Scurvy, p. 300. 

!| Parerga Medica, p. 311. 



102 PATHOLOGY OF THE 

pox ; but, on the other hand, are subject to vio- 
lent scurvies, which at times sweep off as great 
numbers as the small pox does of other na- 
tions." 

A mixture of vegetable substances with our 
food, therefore, seems requisite towards the ge- 
neration of good chyle, and to correct the con- 
tinual alkaline and putrescent tendency of the 
animal fluids. The proportion of these, how- 
ever, will depend greatly on circumstances. 
The inhabitants of very cold countries, as Green- 
land, Lapland, and Hudson's Bay, can sustain a 
diet of flesh and fish, with much less impunity 
than those who reside within the tropics, or in 
hot countries, where the septic tendency of body 
is much greater; of consequence they are 
obliged to be much more abstemious of animal 
food, and live more on vegetable and antiseptic 
materials. 

All animal diet is more apt to excite and heat 
the body than vegetable ; and the reason is ob- 
vious : The salts of animals are chiefly volatile 
and alkalescent; but those of most vegetables 
are of a fixed nature and acescent ; and on this 



HUMAN FLUIDS. 103 

account, when received into the blood, remain 
inactive and quiescent without much exciting 
the system: whereas the former, which are 
naturally active and somewhat volatile, and are 
rendered still more so by the heat of the body, 
not only excite a greater agitation in the fluids, 
but likewise irritate the solids, and stimulate the 
several series of vessels into quicker and more 
forcible vibrations. An excess of animal food, 
therefore, without a due proportion of vegeta- 
bles and acescent things, must needs prove un- 
suitable or incongruous to the constitution, and 
not only lead to scurvies and various kinds of 
eruptions, but also predispose the body to 
ardent inflammatory diseases, and to putrid, ma- 
lignant, and pestilential disorders, &c. 

With respect to acrid matters introduced 
into the body from without, many of them have 
long been suspected of being prejudicial to 
health. Acria ingesta, says Be G outer, si tarn 
rigida sint, ut vi vitee superari nequeant, venena 
nobis sunt : quae vero deficile subiguntur longas 
pertinacissimasque segritudines et dolores inferre 
solent: mitiora vero quandoque maxime appe- 



104 PATHOLOGY OP THE 

tuntur, exhibentia, grata stimulantia. Talia sunt 
innumerabilia inusu humano, utacida, salina, aro- 
matica, alcalica, &c. quae omnia, si non nimis ve- 
hementia sunt, in corporibus robustis facile vin- 
cuntur; sed in debilibus diu ssepe latere possunt, 
maxime si simul eorum causam morbificam fove- 
ant : quas vero huic causa3 contraria sunt, medi- 
camenti titulo adhiberi possunt.* 

The body, however, is in some measure pro- 
tected against the admission of any thing of a 
heterogeneous nature, by the power of sensation, 
which, being readily excited into action by the 
irritation of any acrimony impressed, so con- 
stricts the mouths or orifices of the lacteals as to 
exclude many offending matters, except when so 
diluted and blunted as to become mild.f But this 
power is by no means absolute ; nor dothe lacteals 
possess that peculiar appetency, or discriminating 
faculty, for which some have contended: on the 
contrary, there are innumerable evidences that 
foreign matters can be conveyed into the blood 

* De Gorter, Tract, de Perspir. cap. vii. $5 11. 
f Gaubius, Patholog. ^ 297. 



HUMAN FLUIDS. 105 

in their active state.* " A great many substances 
may enter the lacteals along with the chyle, even 
solids reduced to a fine powder."f Solutions of 
indigo and blue-stone are readily absorbed by the 
lacteals of a dog.J The lacteals and lymphatics, 
says Mr. Cruiksha]\ v k, take up the most irritating 
and stimulating substances.^ 

Pathologists have insisted much on the inju- 
ries resulting from an immoderate use of the 
aromatics. But the circumstances of their opera- 
tion are not, perhaps, clearly determined. We 
have reason, however, to suspect their noxious 
influence in those affections of the bladder, which, 
in advanced life, are connected with a tender- 
ness or preternatural sensibility of its neck, or 
perhaps some affection of the prostate gland. 
Common salt is generally supposed to be the 
most innocent of the whole class of acrids, and 



* Vide Smith, Inaug. Dissert, on Absorption, in Caldwell's 
Collection of Theses, vol. 1. Philadelphia. 

f Fordyce on Digestion. 

| Vide Dr. Musgrave's Experiments, in Philos. Trans. Abridg;, 
vol. v. 

^ Anatomy of the Absorbing Vessels, p. 123. 

14 



106 PATHOLOGY OF THE 

indeed would seem to be a necessary stimulus to 
the process of digestion. But even this agreea- 
ble condiment, if too much accumulated in the 
habit, and particularly of such as are of a tender 
constitution, is capable of producing the most 
pernicious effects, as will clearly appear from 
the following remarkable case recorded by the 
late Dr. Peroival. 

" A young lady aged sixteen, tall, thin, and of 
a delicate constitution, though in tolerable good 
health, was advised to use sea water, on account 
of a strumous swelling and inflammation of her 
upper lip. She drank a pint of it every morning 
for ten days successively, which did not pass off 
freely by the usual evacuations. At the end of 
this period, she was suddenly seized with a large 
discharge of the catamenia ; was perpetually spit- 
ting blood from the gums, and had innumerable 
petechial spots on different parts of her body. 
Her pulse was quick, though full, her face pale 
and somewhat bloated; her flesh somewhat ten- 
der; she was often faint, but soon recovered her 
spirits. The flux from the uterus at length 
abated, but that from the gums increased to such 



HUMAN FLUIDS. 107 

a degree, that her apothecary took a little blood 
from her arm. From the orifice blood continu- 
ally oozed for several days. At last an hemorrhage 
from the nose came on, attended with frequent 
faintings, in which she at length expired, choak- 
ed, as it were, with her own blood. Before she 
died her right arm was mortified from the elbow 
to the wrist. And it is further to be remarked, 
that though blood let from her some weeks be- 
fore she began the use of the sea water was suf- 
ficiently dense, yet that drawn in her last sick- 
ness was putrid and dissolved gore."* 

Physicians have frequently had occasion to 
complain of the bad effects of the alkaline salts 
both fixed and volatile, and, indeed, there are 
man} 7 indubitable and well-attested facts of their 
having produced in the human body putrid 
symptoms of various kinds.f Such effects have 
been particularly observed to follow the too 
free use of Mrs. Stephens's famous alkaline 
medicine. Haller observes of this medicine, 



* Percival, Essays, Medical and Experimental, vol. ii. 
f Vide Huxham, Essay on Fevers, &c. 



108 PATHOLOGY OF THE 

that by long use it renders the blood alkaline 
and acrid, and brings on scorbutic and hectic 
symptoms.* As these salts are found to resist 
the putrefactionf of dead animal matter, it might 
appear a little surprising that they should be 
capable of producing putrid effects in the ani- 
mated machine; but the difficulty will in a 
great measure vanish when we consider, that 
they not only promote the dissolution, and, con- 
sequently, the putrefaction of the blood ; but 
further by their stimulating properties they cre- 
ate an excess of heat and motion, which accord- 
ing to Haller,J are among the principal causes 
of putridity in the animal economy. 

An acrimony is likewise generated when the 
body, in a sound state, is not duly supplied with 
the necessary nourishment ; and that the sooner 
in proportion as the vital power is stronger. 



* Sed in vivente etiam homine lixivi sales, qui Stephaniano 

medicamento efficaciam praestant, longo usu sanguinem alcali- 

num, acrem, scorbuticum, hecticumque reddiderunt ; ut etiam 

vesicas de cute elevaverit. Haller, Elem. Physiol, torn. ii. p. 90. 

f Pringle, Diseases of the Army, Append. 

\ Vide Elem. Physiol, torn. ii. p. 80. 



HUMAN FLUIDS. 109 

The animal humours, in consequence of con- 
tinual heat and motion, naturally and constantly 
tend to a state of acrimony and putrefaction. 
One of the principal means employed by nature 
to obviate this dangerous tendency is the 
regular and daily supply which the system re- 
ceives of fresh and nutritious aliment. For 
the office of the chyle is not only to afford 
nutriment to the different parts of the body, but 
also to temperate, dilute, and correct the blood 
itself. When, therefore, the blood is for some 
time deprived of the necessary refreshment of 
this demulcent liquor, it naturally grows more 
acrid and putrescent ; to such a degree at least, 
as will be sufficient to render the whole mass, 
in a few days, unfit for any of the functions of 
life. In a person who has suffered hunger for a 
long time the blood and humours are attenuated 
and rendered more acrimonious, by which they 
incline to putrefaction ; and hence, all the secre- 
tions are rendered acrid and putrescent : what 
is expired from the lungs becomes so very fetid 
and disagreeable that the person is scarcely able 



110 PATHOLOGY OF THE 

to endure his own breath.* Those who die of 
famine have their blood and all the humours first 
rendered highly acrimonious,! which not only 
corrodes the delicate vessels, and sometimes 
induces hemorrhages and effusions of blood in 
different parts of the body, but so injures or al- 
most destroys the tender fabric of the brain and 
cerebellum, as to produce intolerable pains, 
spasms, convulsions, acute fevers, attended with 
raging fury, and at length death itself. J 

* Ulis qui inediam patiuntur, et quorum sanguis novo affluente 
chylo non reficitur, sanguis per se interno calore dissolvitur et 
putrescit, hincque omnia, ex eo sanguine secreta, foetent et acria 
sunt, halitus olet, saliva labia et linguam rodit, sudor ingratus est, 
bilis et cffitera secreta irritant, et ipsas partes solidas, in quibus 
hospitantur, destruunt; nisi enim opportune novo affluente 
latice chyloso restaurentur, totum corruit. Schwenke, Hazma- 
lolog.Tp. 131. 

•j- The blood of those who die of famine becomes highly acri- 
monious, which begets fever, phrensy, and such a degree of 
putrefaction, as is utterly destructive of the vital principles. 
Huxham, id antea. 

| Ostendimus, etiam modico a jejunio fetere animam, etiam 
in purissimo feminse corpore. Sic lac continuo rancescit, et 
urin* intoleranda fit acrimonia. Sed diutius si inedia protracta 
merit, ab erosis ut videtur nervis, dolores non tolerandi nascim- 



HUMAN FLUIDS. 11 1 

The use of hard and indigestible aliments, or 
such as are too tough for the individual constitu- 
tion, and insuperable to the powers of the 
body, will, in like manner, favour the generation 
of acrimony ; for it is easy to understand that 
the chyle, which is drawn from food of this 
character, will not only be less fit for nourishing 
the body, but also deficient in those qualities 
which are requisite to dilute and correct the 
acrimonious and putrescent animal humours. 
Hence, crudities and spontaneous corruptions 
from a want of proper chyle and nourishment. 
But moreover, this crude chyle not being either 
duly elaborated or expelled the body, must ne- 
cessarily of itself, by the heat of the blood, by 
repeated circulations, and continuing long there, 
become acrid and putrescent, together with the 
other juices of the body. It is to this source 



tur, et vasa rumpuntur, ut hasmorrhagijc narium superveniant, et 
sanguis in ventriculum avicularum effusus visus sit, inque intes- 
tina. Celeriter etiam mens emovetur, et merositas primo ctque. 
mentis pene alienatio, et epilepsia, inde demum, delirium, 
deinde plenus furor superveniat, mortemque fere prxcedat. 
Haller, Elem. Physiol, torn. vi. p. 167. 



112 PATHOLOGY OF THE 

that the learned and practical Dr. Lind, in his 
excellent book on Scurvy, has principally attri- 
buted the production of this disease, so far as a 
sea diet is concerned in it. The scurvy, how- 
ever, is not peculiar to seamen or navigators. 
There are instances of its appearance in be- 
sieged towns. It occurs in low, damp situations, 
under the use of unalimentary food, or where 
the diet has been deficient in quantity, or of a 
low quality. Hence it is sometimes observed in 
the train of famine : such was the case in Paris, 
and other parts of France, in the year, 1 699.* 
In two recorded instances this complaint occur- 
red, in the most inveterate degree, in two old 
women who had subsisted, for more than three 
months, on nothing but bread and an infusion of 
tea, without any other ingredient whatever in 
their diet.f 

It is probably in this way, too, that bad and 
unwholsome food, ill ripened fruits of the 
earth, &c. do not unfrequently produce malig- 
nant and pestilential diseases : for the juices, 



" Blane, Diseases of Seamen, p. 191. 

i Milman, Inquiry into the Scurvy and Putrid Fevers, p. 25i 



HUMAN FLUIDS, 113 

with which such supply the Mood, being cor- 
rupted, must necessarily form a fluid unfit 
both for nutrition and the animal secretions. 
Hence it is, that famine is not unfrequently suc- 
ceeded by pestilence, agreeably to the proverb, 

A0//U0C /WET* Mf/.lv. 

The blandness of our fluids is likewise de- 
stroyed both by an excess of motion, and by a 
want of motion in them; and thus the same 
effect will be produced, by two directly oppo- 
site causes. 

But nothing, perhaps, more favours the gene- 
ration of acrimony in the body, than the irre- 
gularities of those operations by which secre- 
tion and excretion are effected. The continual 
exercise of the animal functions produces, in the 
human body, an acrimony which is dissolved in 
the serosity of the blood, and is usually covered 
by bland nutriment continually supplied until 
carried off by the fluids denominated, for this 
reason, evcrementitious. If, however, the secre- 
tion or excretion of these noxious materials be 
prevented by any cause, so that they be retained 
in the animal economy, an acrimonious state of 

15 



114 PATHOLOGY OF THE 

the fluids necessarily follows. What this acri- 
mony is, we do not perhaps clearly and exactly 
know. It appears, however, to be partly of a 
saline, or, rather an alkalescent nature, and very 
probably contains some considerable admixture 
of septic particles. 

The generation of this acrimony in the fluids 
is much facilitated by an increase of heat and 
motion. Hence it goes on much more rapidly 
in fevers : and the changes then wrought upon 
the humours are rendered more conspicuous. 
It is certain, that the urine is always rendered 
more strong, fetid, and acrimonious, in propor- 
tion to the violence or rapidity of the circula- 
tion. In weak persons unaccustomed to exer- 
cise, it is limpid, pale, without smell, and not 
very salt to the taste ; but in a strong person, 
whose body is exercised by labour or motion, it 
is more red and fetid, and very saline. " If, there- 
fore, the motion of the blood through the vessels 
be increased, it will make the salts of the blood 
to become more acrid and volatile ; the oils also, 
will grow thinner, and be less mild ; these, again, 
will form a fresh stimulus to increase the circu- 



HUMAN FLUIDS. 115 

lation, from the increase whereof they deduced 
their origin, -and the effect of a disease will 
increase the disease itself."* 

An acute and ardent fever is capable in a few 
days of so changing the texture of the blood, 
and corrupting the state of the humours, as to 
strongly incline them to a putrid and alkaline 
disposition. The blood, indeed, can never be so 
far corrupted as actually to become alkaline, 
whilst circulating in the vessels of the living 
body ; for death itself would first be produced 
by the destruction occasioned to the very small 
vessels, and the delicate contexture of the cere- 
brum and cerebellum. It may be questioned 
whether even the urine itself, which is the true 
lixivium of the blood, has ever been found to 
become actually alkaline, even in the most ar- 
dent, or most putrid fever; except, perhaps, 
where it has been a very considerable time in the 
bladder before discharged. Still, however, the 
blood and humours may become so far alkales- 
cent, that is, tend so strongly to an alkaline state, 

* Van Swieten, Coramentar. ^100. 



iJ6 PATHOLOGY OF THE 

as to render them unfit for the purposes of life 
and health. This tendency to an alkaline con- 
dition ought not to be confounded with that 
which is really alkaline. 

Nature has instituted two principal evacua- 
tions by which the blood is freed from these 
noxious and excrementitious parts. These are 
wine, and insensible perspiration both cutaneous 
and pulmonary. 

The urine is a sort 'of aqueous lixivium, or 
the ablution of all the oils and salts of the 
blood, that were rendered too acrid to be retain- 
ed with impunity in the circulation. It is of all 
our liquors the most easily putrescent,* and 
consists of a water containing salts and oils 
approaching to a state of putrefaction.f The 
urinary passages, therefore, are destined to carry 
off and cleanse the blood from those noxious, 
acrimonious, and putrescent matters which, if 
retained by any cause, would be productive of 
the most dangerous or fatal effects. The acri- 
mony thus induced, being increased by the heat 

y 

* Richerand, Elements of Physiology, p. 94. 
f Boerhaate, Elem. Chera. torn, ii. proc. 100. &^c. 



HUMAN FLUIDS. 217 

of the body and the action of the vital parts 
every moment, would soon become intolerable 
to the more delicate vessel?, and dissolving to 
the humours, by a urinous and most pernicious 
quality. It soon shows itself in its effects on 
the tender vessels of the brain and cerebel- 
lum; for which reason those who die of a sup- 
pression of urine, have all the functions of 
the brain first disordered : they usually become 
comatose, delirious, are sometimes convulsed 
before death, but more generally go off quietly 
in a fatal sleep,* " A sufficient attention," says 
an eminent physiologist of the present day, 
"has not hitherto been given to the symptoms 
of a urinous fever, or affection occasioned by 
a too long retention of this liquid in the cavity 
of the bladder. I have frequently had occa- 
sion to observe, that no disease gave better 
marked signs of what physicians call putridity. 
The urinous and ammoniacal odour exhaled 
from the whole body in sickness, the yellow, 
greasy moisture covering the skin, the great 



* Van Swietejs, Commentar. 



118 PATHOLOGY OF THE 

thirst, the dryness and redness of the tongue 
and throat, the frequency and irritation of the 
pulse, joined to the flaccidity of the cellular 
membrane; all indicate that the animal sub- 
stance is menaced with speedy and prompt 
decomposition."* 

The urine is likewise a humour interesting to 
the physician on many other accounts. The 
characters exhibited by this fluid are sometimes 
of considerable importance in distinguishing the 
nature and various states of any disorder. To 
those, too, who know how to form a judgment 
upon its properties and appearances, it is not 
unfrequently of assistance in deducing satisfac- 
tory indications of practice. A proper know- 
ledge of the nature of the principles which it 
carries off in certain circumstances, affords much 
information respecting the disposition of the 
constitution and the predominant principles ia 
the fluids of the human body. 

But the most considerable, perhaps, of all the 
evacuations from the human body, is the matter 



* Richerand, Elements of Physiology, p. 95. 



HUMAN FLUIDS. 119 

of perspiration; the constant and equable dis- 
charge of which appears scarcely less necessary 
to life and health, than that of the urine itself. 
Its importance, too, rests not merely on its free- 
ing the blood from noxious or excrementitions 
matters; but it is further useful in maintaining 
a due equilibrium between the solids and fluids 
of the system ; in preserving the skin in a proper 
state of softness and pliability ; and, lastly, in 
being one of the great and principal means em- 
ployed by nature to diminish the effects of in- 
creased excitement, by carrying off the super- 
fluous animal heat, and thereby moderating the 
temperature of the body, and preventing the 
individual from receiving a degree of heat supe- 
rior to what is fixed by nature. 

It is owing principally to this latter circum- 
stance that animals can for some time endure 
without injury a temperature much higher than 
could have been supposed. The experiments of 
Tillet, of Fordyce and his associates, and of 
others, are well known.* By these experi- 

* Fide Rees' Cyclopxdia, art. Heat; also, Phil. Trans. 



120 PATHOLOGY OF THE 

ments we learn, that persons have for a con- 
siderable time remained in an atmosphere heated 
to a temperature exceeding the boiling point 
of water. Nature has in this respect most 
amply displayed that system of general liberty, 
which she appears to have been so desirous 
of establishing in every thing relating to the 
animal machine. If the causes by which man 
is affected are various, his resources are equally 
multiplied: his temperature is adapted both 
for motion and repose ; he lives equally in all 
temperatures and in all climates. When in 
a cold medium his perspiration is diminished, 
and there is of consequence a less expenditure 
of animal heat ; the density of the air, too, be- 
ing greater, it has a more considerable contact 
with the blood in the lungs; whence more 
air is decomposed, and the evolution of caloric 
proportionably increased, which repairs the ex- 
penditures occasioned by external cold. On the 
contrary, when he finds himself in a hot cli- 
mate, where the air is more rare, and has of 
consequence less contact with the blood in the 
lungs, less of it is decomposed;, less caloric is 



HUMAN FLUIDS. }2l 

disengaged, and from the establishment of a 
more abundant perspiration, a proportionably 
greater quantity of heat is carried off by the 
continual evaporation from the surface. Hence 
it is, that the natural temperature of the living 
human body is nearly the same in all climates 
and at all seasons of the year. But to return ; 

That a moist vapour is continually exhaling 
from the surface of the body, is evident from 
a variety of circumstances. When from any 
cause the quantity of this perspired vapour is so 
much increased as to appear on the surface con- 
densed into a liquid or sensible form, it is then 
denominated sweat. But when it passes off in an 
invisible state, it is generally called insensible, or 
sometimes Sanctorian perspiration, in honour of 
Sanctorius. It would seem, however, to have 
been well known to Hippocrates, who, in a few 
words, observes, that the whole body both exhales 
and inhales '. " *Wv«6,v &&} sjwvoov Saov to a-*^*."* 

Many experiments have been made for the 
purpose of ascertaining the quantity of matter 



* Hippocrates, De Morb. Vulg. lib. vj. sect. vi. 
16 



122 PATHOLOGY OP THE 

perspired by the human body. The first who 
made any estimate of this considerable dis- 
charge was the celebrated Sanctorius,* who 
continued his observations for no less than thirty 
years. A similar set of experiments was after- 
wards made by Dodart,! in France, by Keil 3 J 
in England, by the learned De Gorter,& in 
Holland, by Robinson|| and Rye,U in Ireland, 
fcnd by Lining,** in South Carolina. On this 
'subject, too, we have the still more recent 
and interesting experiments of CRUiKSHANK,ff 
Home,JJ Abernethy,^ and others. 

The quantity of matter perspired appears to 
differ very considerably according to circum- 



* Medicina Statica. 

f Haller, Elem. Physiol, torn. v. 

X Medicina Statica Britannica. 

^ Tract, de Perspir. Insensib. 

|| Treatise of the Animal Economy. 

1F Med. Stat. Hybern. in Rogers on Epidemics? 

** Philosophic- al Transactions. 

ft On Insensible Perspiration. 

IjX Medical Facts and Experiments. 

^ Surgical and Physiological Essays, 



HUMAN FLUIDS. 123 



stances. In the climate of Italy, Sanctorius 
ascertained it to be equal to five eighths of all 
the meat and drink taken into the body. It is 
unquestionably one of the most copious of the 
natural evacuations ; " and though it is some- 
times in greater or lesser quantity, as influenced 
by various causes, yet it can never be partially 
suppressed long, much less can it be entirely 
obstructed, without the greatest detriment to 
health. For should its defect for a short time be 
supplied by some more copious and increased 
evacuation, as it sometimes is by that of the 
urine; yet, towards perfect health, the inte- 
grity of all the animal functions, more espe- 
cially the natural evacuations, are requisite: 
there being somewhat thrown out of the body 
by each, which cannot so conveniently pass 
another way ;"f and, as Sanctorius very justly 
remarks of any other evacuation substituted 
for this, " ilia tollit copiam, sed relinquit malam 



* Si cibus et potus unius diei sit ponderis octo librarum, 
transpiratio insensibilis ascendere solet adquinquelibras cirtiter. 
Aphor. 6. 

f Lind, on Scurvy, p. 275. 



124 PATHOLOGY OP THE 

qualitatem ;"* it diminishes the quantity, but 
leaves behind it the ill quality. 

The matter of perspiration is of two kinds., 
the aeriform and the aqueous. The former, 
which is small in quantity compared with the 
latter, consists of two different gases, to wit, the 
carbonic and the azotic.f The principles of the 
aqueous perspiration are, perhaps, nearly allied 
to those of the urine, only the former usually 
abounds more in a sort of oleaginous matter, 
from being thrown off from the blood after it has 
undergone a longer and much more elaborate ac- 
tion of the vessels, and when its principles are 
more thoroughly incorporated. 

But whatever may be the chemical analysis of 
the perspirable matter, it is evidently destined 
For excretion. As the health of the human bod v 

if 

greatly depends upon the due and regular separa- 
tion and expulsion of excrementitious matters, 
so the constant and equable discharge of the per- 
spirable materials must be of the first import- 



* Aphor. 19. 

4 ACERNETHT, loC. tit. 



HUMAN FLUIDS. 125 

ance, as it regards the healthy state of the body -„ 
for being a production of the last and most 
elaborate scene of animal digestion, the blood 
is hereby freed of what is consequently the 
most subtle and putrescent of the animal fluids. 
And it is certain that the perspirable humours, 
when retained long in the body, are capable of 
acquiring the most noxious qualities, and even 
putrefaction itself;* becoming highly acrimo- 
nious, which is increased every moment by the 
action of the vital parts. Hence arise various 
morbid affections, according to the habit of body, 
the constitution of the individual, and the influ- 
ence and determination of other causes. 

Of the noxious qualities of the matter of per- 
spiration, there can scarcely be more strong and 
positive proofs than those afforded by the expe- 
riments of Dr. Alexander. By these it is ren- 
dered evident that both the pulmonaryf and 
cutaneous% exhalations of the human body, even 



* Sanctorius, Aphor. 43. 46. 149. 176. Sfc. 
T Alexander, Experimental Essays, p. 53. 
| Ibid. Experimental Inquiry, cap. iii. 



126 PATHOLOGY OF THE 

in the most healthful, are constantly replete with 
septic particles. 

It is owing principally and especially to this 
circumstance, that the air is frequently rendered 
so poisonous and corrupt in jails and all other 
confined and ill ventilated apartments, where a 
multitude of persons are closely shut up together, 
and constantly and repeatedly breathing the 
same air; whereby the whole atmosphere of the 
place soon becomes an accumulation of highly 
septic miasmata, which being rendered more 
active and virulent by heat and stagnation, at 
length assume a putrefactive contagion capable 
of producing the most malignant disorders. 
Hence it is, that air, often expired and replete 
with animal steams or exhalations, is, of all 
others, the strongest predisposing cause of putre- 
faction. The malignant and highly infectious 
nature of the air of close and crowded jails has 
long been known. " The most pernicious infec- 
tion, next the plague, (says Lord Bacos,) is the 
smell of the jail, when the prisoners have been 
long, and close, and nastily kept; whereof we 
have had in our time experience twice or thrice, 



HUMAN FLUIDS. 127 

when both the judges that sat upon the jail, and 
numbers of those who attended the business, 
or were present, sickened upon it and died. 
Therefore it were good wisdom that in such 
cases the jail were aired before they be brought 
forth."* 

But it were superfluous longer to dwell upon 
the nature, effects, and importance of perspira- 
tion. It is intimately connected with health. 
Its influence in modifying the character of 
disease has long been known, and particularly 
demonstrated by those who have most success- 
fully directed their attention to the nature and 
cure of febrile, and of malignant and pestilen- 
tial diseases. Of all the various methods had 
recourse to in the treatment of the yellow fever, 
which has at different times prevailed in the 
United States, what may be denominated the 



* Bacon, Works, vol. ii. p. 49. Lond. ed. 1803. Vide also 
Blane, Diseases of Seamen ; Lind, Papers on Infection and 
Contagion ; Chisholm, Essay on the Malignant Pestilential 
Fever; Ibid. Letter to Hatgarth; Sir John Pringle, Dis- 
eases of the Army ; Ferriar, Medical Histories and Reflec- 
tions ; Hatgarth, on the Small Pox, &c. 



128 PATHOLOGY OF THE 

sudorific plan appears to have been by far the 
most successful. Its decidedly beneficial effects 
were amply evinced in the long and extensive 
practice of the venerable Dr. John Bard, and 
of Dr. Samuel Bard, during the repeated visi- 
tations of that epidemic in the city of New- 
York, since 1743.* Its advantages over the 
mercurial plan of treatment were fully tested in 
the practice of Dr. HosACK.f 

A similar remark may be made concerning 
the importance of the sudorific method of cure 
in the typhoid peripneumonia, which, within 
these few years past, has so extensively prevailed 
in the eastern and middle states. " The prac- 
tice which has been by far the most generally 



* MS. Notes on Hosack's Lectures on Theory and Prac- 
tice of Physic and Clinical Medicine. 

f See also Dr. John Mitchill's Account of the Yellow 
Fever of Virginia ; Hosack and Francis' American Medical 
and Philosophical Register ; Facts and Observations, and Addi- 
tional Facts and Observations of the College of Physicians of 
Philadelphia ; Hosack, on the Yellow Fever of New- York, in 
Currie's Sketch of the Yellow Fever of Philadelphia; 
Currie, on Synochus Icteroides ; and other writers jn 
Mitchill and Miiler's Medical Repository, &c. 



HUMAN FLUIDS. 129 

pursued, and considered of primary importance," 
observes the committee of the Massachusetts 
Medical Society, in their elaborate and interests 
ing Report, " is to produce early and long con- 
tinued sweating."* "By this evacuation we 
$iot only counteract the general vitiated state of 
the fluids, but we at the same time diminish, and 
in some cases, totally remove the local irritation 
which affects the lungs and other organs involved 
in this disease."f The observations of Dr. 
Williamson, made during the prevalence of 
the same disorder in North Carolina, lead to the 
same conclusions.:}: 

Thus far of the nature, causes, and effects of 
acrimony in general. To enter into a conside- 



* Vide Report of the Mass. Med. Society, in their Medical 
Papers, vol. ii. part ii. 

f Hosack, on the Peripneumonia Typhodes, in the Amer. 
Med. and Philos. Register, vol. iii. p. 452. 

\ Observations on the Malignant Pleurisy, in Amer. Med. and 
Philos. Register, vol. iii. p. 453 ; see also New- York Medical 
Repository ; New-England Journal of Medicine and Surgery ; 
Low, on the Epidemic Pneumonia, and other papers in {he 
Amer. Med. and, Philos. Register. 

17 



130 PATHOLOGY OF THE 

ration of the different kinds of acrimony that 
have been noticed in the schools, or to attempt to 
investigate their peculiar nature or specific 
quality, is deemed unnecessary. Nor, indeed, 
does it much signify as to the effect produced, 
what the acrimony is; acrimonious substances 
differing principally in a greater or less degree, 
and a more or less durable action.* They all 
appear to act as stimuli in irritating the solids and 
in exciting the action of the heart and arteries ; 
while at the same time they tend to destroy the 
healthy crasis of the blood and humours. 

But according to the different nature of each, 
peculiar medicines must be employed to correct 
and oppose the particular kind of acrimony. 
In general it will also be necessary to have re- 
course to a judicious employment of diapho- 
retic remedies; and to dilute and carry off the 
acrid materials, by the plentiful use of diluent, 
watery, and mucilaginous drinks and medicines ;f 



* Van Swieten, Commentar. 

f HoffbjaNj Medicin. Rational System, torn. iv. part. r„ 
cap. I, 



HUMAN FLUIDS, 131 

with which it will, for the most part, be proper 
to mix acids, both vegetable and mineral, espe- 
cially where there is much excitement, where 
heat is to be moderated, a tendency to putrefac- 
tion prevented, or where the acrimony is of the 
alkalescent or putrescent kind. For it appears, 
that acids are both highly refrigerant and anti- 
septic ; and whether in these circumstances they 
produce their beneficial effects by diminishing 
sensibility and irritability ; or by correcting and 
changing the alkalescent salts ; or by condensing 
the humours and fibres; or in all these ways, is 
of little consequence.* 

It would also be foreign to our purpose 
to particularize the various degrees and sorts of 
acrimony or other morbid qualities which may 
be produced in the blood and humours by the 
introduction of various miasmata, or specific con- 
tagions. It may be observed, however, that 
each species of contagious particles produces a 
distemper of its own kind. Thus, the variolous 
effluvia produce the small pox, the morhillous 



* Burserius, Institutions of the Practice of Medicine, vol. 



132 PATHOLOGY OF TH& 

Hie measles, the pestilential the plague, and so of 
other diseases propagated by specific contagions. 
But the extreme subtlety of contagious miasmata 
is such as to elude the examination of the senses ; 
of consequence we are unable to ascertain their 
peculiar nature or qualities, and must rest con- 
tented with being able to trace their operation 
and effects upon the living human body. One 
circumstance, however, connected with the ope- 
ration of contagions, and which particularly 
characterizes their action, is that wonderful fa- 
culty which they possess of transmuting many 
parts of the sound humours of the human body 
into a similitude with themselves ; and thereby 
diffusing through the blood a morbid quality of 
the same species and denomination with the 
disease from which they originally proceeded, 
But of this more will be said hereafter. 

How these subtle and invisible miasmata* 
when received into the body, are able so to 
injure the texture of the solids and fluids, and 
excite such wonderful commotions in the sys- 
tem, it is impossible to say. But that such 
effects may proceed from acrid poisons, plainly 



HUMAN FLUIDS. 133 

appears from what happens to those bit by the 
haemorrhois, a Lybian serpent, the effects of 
which are so beautifully described by Lucan : 

Impressit dentes Haemorrhois aspera Tullo, 
Magnanimo juveni, miratorique Catonis. 
Utque solet pariter totis se effundere signis 
Corycii pressura croci, sic omnia membra 
Emis&re simul rutilatum sanguine virus. 
Sanguis erant lacrimse : quaecumque foramina novit 
Humor, ab his largus manat cruor: ora redundant, 
Et patulse nares : sudor rubet : omnia plenis 
Membra flaunt venis : totum est pro vulnere corpus.* 

* Pharsalize, lib. ix. v. 8ff#, 



Dissolved and Putrescent State of the Blood. 

Beside the several morbid conditions of blood 
which have already been noticed, there is 
another of a still more dangerous and compli- 
cated nature, and in which this humour more 
immediately tends to dissolution and putrefaction. 



134 PATHOLOGY OF THE 

Such evidently appears to be the case in some 
scorbutics, and likewise in putrid, . malignant, 
and pestilential fevers. 

What degree of resolution in the blood is 
necessary to denominate this fluid putrescent, 
or putrid, or to what extent a putrescency of it 
may actually take place while circulating in the 
vessels of the living human body, is difficult to 
determine ; but such a degree of corruption, or 
putrefaction, as is by some authors spoken of, is 
certainly incompatible with life. 

As soon as the principle of animality or life 
abandons the body, it becomes immediately and 
totally influenced by physical laws, to which all 
inanimate and inorganized bodies are subject. 
It now performs a retrograde process, and be- 
comes decomposed. This decomposition, which 
is called putrefaction, totally destroys the natu- 
ral texture or consistence of the animal sub' 
stance, and produces an entire resolution of its 
component principles. 

The capacity of change in bodies is in a 
direct ratio with the multiplicity of their ele» 
mentsj so that the preservation or existence of 



HUMAN FLUIDS. 135 

an organized being after death is protracted 
so much the longer in proportion as its con- 
stituent principles are less numerous and vola- 
tile.* It is for this reason that the fluid and 
softer parts of our body putrefy more readily 
than the solids or firmer parts. Putrefaction, 
indeed, never takes place in those animal sub- 
stances which contain only two or three ingre- 
dients, such as oils, resins, fyc. but they must 
always be more complicated in their texture or 
composition.f 

But however complicated the animal sub- 
stance, it does not putrefy without the presence 
of a certain degree of heat and moisture, which 
are the two great and essential requisites to 
putrefaction. Both of these requisites exist in 
the living system, and the former, too, according 
to the valuable experiments of Dr. Alexander, 
about that degree which is best calculated to 
promote the putrefaction of dead animal mat- 
ter. This process also advances with greater 



* Richkrand, Elements of Physiology, p. 462. 
} Thomson, System of Chemistry, vol. v. p. 770, 



13(3 PATHOLOGY OF THJ5 

rapidity in the open air ; " but exposure to air 
is not necessary, though it modifies the decom- 
position."* In this respect also, the human body 
is in that situation in which putrefaction would 
most readily take place ; for there is not only a 
constant application of the ambient air to the 
surface of the body, but it also enters deeply 
within by respiration ; and we are perpetually 
swallowing the same with our food and drinks ; 
so that it is not improbable that a portion of air 
may be intermixed or combined with our fluids, 
and even incorporated with the solids themselves. 
It is fully ascertained, that a small quantity of 
air may be gradually and slowly conveyed into 
the veins of an animal without producing 
death.f The celebrated Huxham, indeed, thinks 
it probable, that elastic air is sometimes even 
generated in the blood vessels, in putrid fevers. 
The learned Dr. Pringle was induced to believe, 
that several symptoms in the true scurvy might 
be owing to the action of air, within the vessels, 



* Thomson, ut supra. 

j Vide Pringle, Diseases of the Army, Append, p. Ixxxix. 



HUMAN FLUIDS. 187 

either wholly detached from the blood and other 
humours, or but loosely connected, or imper- 
fectly incorporated with them. 

Since, then, the living body is constantly 
under all the necessary and most powerful cir- 
cumstances of putrefaction, and nevertheless 
the whole body of a living person has never 
been found absolutely putrid ; it necessarily fol- 
lows, that there is in life itself, independent of 
every other circumstance, a preservative power, 
which by its influence effectually resists putre- 
faction, and keeps the animated machine from 
total decomposition. 

It has been alleged, that the great and prin- 
cipal means by which the human body is pre- 
served untainted by putridity, is the constant 
elimination of putrescent matters from the sys- 
tem by the various excretions, and the daily 
succession of fresh materials from without, 
w r hich repair the expenditures and degeneracies 
occasioned by the actions of life.* This doubt- 



* Caro animata cur vivit et non putrescit ut morlua ? quia 
qnotidie renovatur. Sanctorius, Aphor. 80. 

18 



138 PATHOLOGY OF THE 

less has very considerable influence in this 
respect; but it is nevertheless of subordinate 
importance compared with the astonishing anti- 
septic powers of the vital principle. For it is 
well known, that a person may live under every 
situation most proper for putrefaction, without 
any sensible evacuation from the body, or with- 
out any thing being taken in for twenty-four 
hours ; and yet no general and absolute putridity 
shall take place. If, however, the same person 
had from some accident been suddenly deprived 
of life, and the dead body been retained for the 
same time in a temperature of 98 of Fahrenheit, 
a violent degree of putrefaction would have 
taken place. 

In order to establish general putrefaction in 
the body, it must be absolutely deprived of life. 
The living principle, whatever it may be, forms 
the most powerful antiseptic. It is this prin- 
ciple which, being universally diffused through- 
out the whole body, incessantly acts upon both 
the solids and fluids, and so long as it remains 
unimpaired effectually preserves the animal sub- 
stance from dissolution. It modifies., without 



HUMAN FLUIDS. 139 

ceasing, the impressions of external agents ; and 
impedes the degenerations depending upon the 
actions of life, or upon the constitution itself. 

In proportion, therefore, as the vital power is 
either weakened or destroyed, the tendency to 
putridity in, the body will become more strong. 
Hence it is, that the strongest putrid symptoms 
generally appear so soon in all fevers, which are 
attended with early and universal debility, or 
with great and sudden depression of strength. 
The celebrated Beccher, in speaking of the 
causes which produce putrefaction in living bo- 
dies, elegantly observes : — " Causa putrefactionis 
primaria defectus spiritus balsamini est.* 

The blood in the aggregate possesses pre- 
servative properties, which it derives from the 
living principle it contains in common with the 
solids. The doctrine of vitality in this fluid, as 
we may learn from sacred history, has been 
entertained from the remotest antiquity ,f The 



* Beccher, Physica Subterranea, lib. i. 
i Vide Leviticus, chap. xviL 



14D PATHOLOGY OF THE 

same opinion was entertained by Aristotle,*" 
and by many other ancient philosophers. This 
idea is also clearly expressed by Virgil : 

Ille rapit calidum fustra de vuluere telum : 

Una eademque via saDguisque animusque sequuntur.f 

The great Harvey, in his celebrated work on 
animal generation, expresses, in the most decided 
manner, his belief, not only that the blood is 
itself possessed of vitality, but that it is the im- 
mediate source of being and life to the rest of 
the system. Among other innumerable obser- 
vations to the same effect, he has the following. 
Clare constat, sanguinem esse partem genitalem, 
fontem vitse, primum vivens et ultim© moriens, 
sedemque anirnse primariam ; in quo (tanquam 
in fonte) calor primd, et praecipue abundat, 
vigetque ; et a quo reliquse omnes totius corpo- 
ris partes calore influeirte foventur, et vitam 
obtinent.J The first, however, who brought 



* De Hist. Anim. lib. iii. cap. 19. 

f Virgil, iEnid, lib. x. v. 486. 

t HaryeYj De Generat. Anim. Exerc.li. 



HUMAN FLUIDS. 141 

this subject to the test of experiment, was Mr. 
John Hunter. His interesting and well direct- 
ed inquiries and observations ; and still more 
recently those of the able and ingenious Dr. 
Caldwell* of Philadelphia, have most satisfac- 
torily established this physiological fact. 

Since, then, the blood evidently appears to 
possess vital powers in common with the solids 
themselves, and since life and putrefaction are 
two ideas absolutely contradictory and incom- 
patible with each other ; it necessarily follows, 
that an absolute and universal putrefaction of 
this fluid can never take place during life. Of 
a quality of this active nature, inevitable death 
would be the immediate consequence. The 
term putrid, then, which conveys the idea of 
actual decomposition and death, is improperly 
applied to express any morbid condition of the 
vital fluid, which occurs during its circulation 
through the vessels. 

When, therefore, in particular diseases, the 
animal fluids undergo certain changes, tending 

* Experimental Inquiry on the Vitality of the Blood. 



142 PATHOLOGY OF THE 

more or less to a state of putrefaction, this ten- 
dency to putridity ought not to be confounded 
with putridity itself. Such an incipient state of 
putrefaction in the humours will be more accu- 
rately expressed by the term putrescent, or pu- 
trescency, not as signifying a state of actual 
putridity, but a near approximation to such 
condition; that is, when the humours have so 
far degenerated that they would undergo de- 
composition and putrefaction with far greater 
ease, and more facility, than when in a sound 
and healthy condition. 

It is the opinion of some of our most dis- 
tinguished physiologists, that even the most 
healthful bodies have naturally and constantly 
some tendency to a state of putrefaction, which 
appears especially in the evolution and genera- 
tion of those saline and putrescent matters which 
are carried off by the natural excretions. If 
such be the case in health, it must obviously be 
much more so in certain diseases ; and that, per- 
haps, to such a degree as eventually at times to 
overcome the vital principle itself. Now, the 
seat of this affection appears to be more espe- 



HUMAN FLUIDS. 143 

cially in the blood and other fluids. It is with 
the view of averting the evil that would neces- 
sarily ensue to the system at large, were the 
death and putrefaction of the blood permitted, 
that there are particular organs which are espe- 
cially destined to supply it with a daily influx of 
fresh materials, and preserve the whole in a reno- 
vated and living condition. It is obvious that all 
aliment, previously to its being able to nourish 
or transfer any restorative influence to the mus- 
cular or more solid parts, must, in the first place, 
make its way into the vital fluid. When deprived 
for any considerable time of this necessary re- 
freshment from cooling and nutritious aliment the 
blood and all the humours, as was before ob- 
served, become more acrid and putrescent. An 
animal that is starved to death does not appear 
to perish from inanition, or from an insufficient 
quantity of blood and other humours; but 
rather from a corrupt and putrescent state of 
them : in proof of which the use of water alone 
will keep it much longer from starving. But as 
water is entirely destitute of those mucilaginous 
principles, which are at present esteemed the 



144 PATHOLOGY OF THE 

nutritive part of our food, it can scarcely be 
supposed that it produces this effect by affording 
any nourishment. It must therefore do it by 
diluting the fluids, or carrying off the noxious 
matters, and in this manner preserving them from 
this putrescent state. Dr. Lind* remarks, that 
he has always observed that the most rigorous 
of the Romish clergy, who are in the habit of 
frequent fasting, are greatly scorbutic, and re- 
markable for a fetid and most offensive breath, 
" Can we ascribe this sudden effect of fasting to 
a disease originating in the solids? Is it not 
more consonant to the laws of the economy, 
that the blood being deprived of regular sup- 
plies of mild and nutritious chyle, must be first 
affected by this loss, and that the solids suffer in 
a secondary way only."f But whether the 
putrefactive tendency be more strong in the 
solids or in the fluids, we may justly suppose that a 
quality of the active nature of putrefaction would 
quickly communicate its pernicious taint to eve- 
ry part of the corporeal frame. 



* On Scurvy, p. 328. 

•J Walker, on Small Pox. p, 108, 



HUMAN ELUIDS. 145 

With respect to the peculiar or actual condi- 
tion of the blood in those diseases usually deno- 
minated putrid or malignant; though it can 
hardly be supposed, that a true and perfect putre- 
faction of this fluid, corrupting the whole mass, 
totally destroying its mixture, and resolving its 
component parts, can for the shortest time exist 
in the living body, it being repugnant to, and 
entirely incompatible with life ; yet an approxi- 
mation or rapid tendency to this state, or rather, 
what Professor Hosack, in his lectures on the 
theory and practice of physic, very aptly and 
judiciously denominates an incipient putrefaction, 
is compatible with life, though not with health, 
and evidently takes place in such diseases. 

This putrescency, or incipient putrefaction of 
the fluids in certain disorders, is evident, in the 
first place, from the appearances of the blood 
itself, when drawn from the vessels. The in- 
genious Dr. Milman, in his inquiry into the 
source whence the symptoms of the scurvy 
and of putrid fevers arise, very properly de- 
scribes the effects of putridity on the blood. 
a If putridity,'* says he, " actually took place 

19 



146 PATHOLOGY OF THE 

in the vital fluid, its effects would be, to break 
down the texture of its parts, as it does that of 
every body ; it must render it incapable of coa- 
gulation."* Now, this is a condition of the 
vital fluid very similar to what physicians have 
noticed in certain diseases, particularly in 
putrid, malignant, and pestilential fevers ;f in 
some scorbutics;}: and in the putrid,^ or pete- 
chial feverll of small pox; in all of which the 
crasis of this fluid is much injured and dissolved. 
The consistence is very different from the ordi- 
nary appearance of healthy blood, its texture 



* Milman, Inquiry, p. 55. 

f In rnorbis putridis dissolutio cruoris quoque advertitur, 
prcesertim pestis specie, in quibus non coagulatur sanguis, sed 
gangrsenosus et putridus reperitur ; quod etiam in eo sanguine 
observatur, qui post protractam inediam putridus et alcalinus 
factus est. Schwenke, Hozmatolog. p. 129. 

% Vide Huxham, Essay on Fevers ; Ibid. De Aere et Morb. 
Epidem. 

55 Walker, on Small Pox, p. 109. Sec. 

|| Nam in tanta pestilentia (scil. variolas,) sanguinis crasis 

dissolvitur penitus, et maxime putrescunt humores : imo cruor 
emissus, putris instar saniei, diffluit; nee ut solito, in frigore 
coagulatur. Huxham, De Aere et Morb. Epidem. vol. i. p. 105. 



HUMAN FLUI&S. 147 

being so much weakened, or broken down, that 
either the coagulum is very loose, or it does not 
coagulate at all, or show any disposition to sepa- 
rate into crassamentum and serum as usual, but 
the whole remains quite fluid and dissolved. 
Huxham* assures us, that blood of this charac- 
ter always putrefies very soon. 

That acute and accurate observer, the late 
Dr. Fordyce, has noted the appearances of the 
blood through almost all the different stages of 
a putrid fever. In the beginning, says he, when 
the putrefaction has not gone to any great 
length, if blood should happen to have been 
taken from the arm, the coagulum is loose and 
easily broken, the serum being hardly of a 
browner colour than common ; but it becomes 
much more so when the putrefaction is fur- 
ther advanced. In a still further degree it is 
red:f in this case, continues he, on examin- 
ing the red particles with a microscope, many of 



* Essay on Fevers, p. 42. 

t See also Huxham, De Aere et Morb. Epidem. ; and like- 
wise his Essay on Fevers. 



i48 PATHOLOGY OF THE 

them are found diminished in size, and not regu- 
lar spheres, or oblate spheroids ; some have the 
appearance of being broken in two, and look 
like half moons. If the putrefaction goes on 
still further, there is hardly any distinction be- 
tween serum and coagulum.* 

" Blood being drawn in the beginning of 
putrid diseases," says Dr. Shebbeare, " the 
crassamentum, though very rubicund, scarce 
adheres together ; in the process of the disorder 
it becomes still of a looser texture, and more 
putrid hue, till in some very desperate cases, it 
is not better than a sanies or putrid ichor."f 

Beside these several morbid appearances, 
some justly celebrated physicians, and more 
particularly Vander M*Ej$ Fernelius,6 Mor- 

* Fordyce, Third Dissertation on Fever, part i. p. 92. 

f Shebbeare, Practice of Physic, vol. ii. p. 169. 

$ De Morbis Bredanis, p. 14, as quoted by Van Swieteiv. 

^ Sanguis qui per febres putridas detrahitur, sspe animadver- 
titur non solum fcetidus et graveolens, sed et putridus adeo ut 
nee sibi cohserere nee concrescere queat, omnibus scilicet ejus 
lib ris putre dine consumptis. Ferseuus, De Febribus, cap. v, 
p. 246. 



HUMAN FLUIDS. 149 

ton,* Sir John Pringle/J- and others, have even 
mentioned the absolute fetor, or offensive smell 
of the blood recently drawn. 

The putrescent state of the fluids is further 
evinced by 

A loathing of animal food, nausea, vomiting, 
thirst, and a desire of acids. 

By hemorrhages from various parts, without 
symptoms of increased impetus. 

By certain spots or marks called petechia?., 
maculae, and vibices, which are generally sup- 
posed to be owing to the effusions of dissolved 
blood below the skin or cuticle.! 



* Denique notatu dignissimum est, quod mihi nuperrime 
videre contigit, sanguis feminai eujusdam, febre maligna labo- 
rantis, per phlebotomiam detractus adeo fcetebat, ut ex ejus 
tetro odore tarn chirurgus quam adstantes in animi plane deli- 
efuium inciderint. Morton, Pyretolog. p. 2G. 

f On Jail or Hospital Fever, p. 837. 

X Hse macula oriri videntur ab infractis, aut dissolutis, san- 
guinis globulis, arteriolas serosas intrantibus ; dumque ibi hserent, 
petechias formant, aut vibices. Pestiferje semper sunt, quod 
cruorem putridum esse, aut niaxime solutun., denotant: imo- 
adeo sxpe dissolvitur sanguis, ut profusse subsequantuv hemor- 
rhagic. Quod quidem scovbuticis quoque accidit crebro, ciltr* 



150 PATHOLOGY OF THE 

By the fetor of the breath, urine, and per- 
spiration, together with the cadaverous smell of 
the whole body. 

By the peculiar kind of acrid or biting heat 
that is commonly experienced on touching the 
skin of persons labouring under putrid malig- 
nant fevers. The heat at first seems inconside- 
rable, but on continuing the hand a longer time 
upon the skin, a disagreeable, pungent, or sting- 
ing sensation is felt in the fingers, which even 
remains some few minutes after they are removed 
from the sick. This fact has been particularly 
noticed by Sir John Pringle,* and, as he can- 
didly observes, by Galen long before him. The 
same, however, had also been distinctly remark- 
ed by FERNELIUS.f 



ne vel minima febris signa adsint, etsi totus fere corporis habitus 
innumeris violaceis maculis inficitur; qui tamen mox. ac ne 
quidem tale quid somniantes, funesto sjepe sanguinis fluxu 
corripiuntur : iste tamen cruor nunquam, more solito, concrescit. 
Huxham, De Atrt et Morb. Epidem. vol. i. p. 116. 

* Pringle, on Jail or Hospital Fever, p. £92. 

f Calor in febre putrida non mitis ac blandus, sed acer, mordax 
ft qui tangentis sensum acriter feriat, non ipso invasionis initio, 



HUMAN 1'LUIDS. 151 

Lastly, by the surprisingly great and speedy 
corruption that generally takes place in bodies 
dying of putrid, malignant, and pestilential 
diseases.* 

To what has been already said upon the na- 
ture and effects of putrescency, it may not be 
improper to subjoin the following observations 
of Dr. Gregory : Q,uandoque autem massa 
sanguinis putrescit multum, non modo acris fit, 
sed solvitur quoque, segre cogitur, et tenue et 
rarum crassamentum ostendit : quin et ipsse 
particular rubrae dilabuntur et franguntur. San- 
guis vero sic solutus et acer, turn propter salem 
evolutum, turn propter gluten suum rancidum 
et putridum, vasa sua stimulat, eroditque, et ex 
iis elabitur; et maculas primo rubras, postea 
livescentes Tel nigrescentes, tumores, ulcera vix 
sanabilia nisi tempestive putredini occurratur, 



sed vel in augmento, vel in statu, idque maxime si diutius 
corpori manus insideat. Fernelius, De Febribus, cap. vii. 
p. 249. 

* Huxham, De Aere et Morb. Epidem. ; Ibid. Essay on 
Fevers ; Hosack, MS. Notes on the Theory and Practice of 
Physic and Clinical Medicine. 



152 PATHOLOGY OF THE 

sanguinis profluvia ab omni corporis parte vix 
compescenda, et foetorem insignem et intolera- 
bilem halitus et omnium excretionum facit; et 
laxitatem solid arum partium, summamque debi- 
litatem, (quia gencri nervoso veneno est,) et 
mortem tandem, talis corruptio inducit* 

The subsequent quotation from the learned 
Baron Haller, supersedes the necessity of any 
further remarks on this part of the subject; 
Q,ua3 motus musculorum, eadem febris facit, 
qusecunque ejus origo fuerit : dum sanguinis 
motum vehementius augeat. Putrescunt in febre 
humores, et in variolis, et in petechiali genere, 
flavaque ilia insularum antillarum peste, sanguis 
fcetidus per os et nares erumpit. In variolis 
confluentibus penetrabilem foetorem seepe ex- 
pertus, nullis aceti in planas patinas expositi 
contrariis vaporibus satis emendare potui. Ip- 
sum inde lac ebutyratum, et citri succus putrescit. 
Fcetent ante mortem, qui febre paludosa pu- 
trida laborant. Foetorem combustarum sole- 
arum similem, adeoque alcalinum, in malignis, 

* Gregory, Conspectus Medicine. ^ 5S4. 



HUMAN FLUIDS. 153 

sudoremque enormiter olentem Segerus obser- 
vavit. Funestus cadaveris odor in hominibus 
peste laborantibus percipitur, qualem ab aegro 
ipso perceptum memini in bibliopola propriae 
mortis certa praesagia dedisse : is autem in peste 
ordor inficit, lateque malum propagat. Mira 
virulentia humorum in hominibus est, qui peste 
pereunt, et sanguis ipse fcetet, et vapor destillati 
de pestilente bubone puris quasi fulminis ictu 
male curiosum medicum prostravit. Corpora 
hominum peste extinctorum, aut paludosa febre, 
continuo putrescunt.* 

The causes of putrescency in the animal 
fluids, which come next in order for considera- 
tion, being in almost every respect the same with 
those of acrimony, which have been already 
sufficiently dwelt upon, it would be unnecessary 
again to enumerate them in this place. A few 
observations, however, upon some of the princi- 
pal ones may not be improper. 

Neither the whole, nor any part of the living 
human body, notwithstanding it has some of the 



* Haider, Elem. Physiol, torn. ii. p. 85- 
20 



154 PATHOLOGY OF THE 

most powerful causes of putrefaction interwoven 
with its very existence, ever runs into this state 
during life, except previously inclined thereto 
by the operation of some powerful cause or 
causes, though these may not always be disco- 
verable. On the contrary, when life is extinct, 
almost the whole animal substance invariably and 
spontaneously putrefies, unless prevented by the 
influence of forcible agents. But as it respects 
matter and construction, the animate and inani- 
mate body are exactly the same. That the for- 
mer, therefore, is less inclined to putridity than 
the latter, must be owing to something which it 
enjoys during life, but is deprived of when dead. 
Now as to life itself, we are totally ignorant of 
its nature or essence. We know not in what it 
consists, nor even the powers of which it is pos- 
sessed. Respecting its action or mode of pro- 
ducing its various effects, no satisfactory expla- 
nation has yet been given. Instead, therefore, 
of indulging in ideal conjectures concerning 
things which we do not understand, let us rather 
Tendeavour to seek some other cause why the 
animal body is so seldom attacked by putrefac- 



HUMAN FLUIDS. ]55 

tion during life ; and perhaps this eause, if it 
can be discovered, may Ihrow some light upon 
the reasons why the body sometimes does suffer 
by it. 

It was on a former occasion remarked, that 
one of the principal means employed by nature 
in obviating or retarding the tendency of ani- 
mals towards a putrid state, is the regular and 
constant supply which the blood daily receives 
of fresh and antiseptic materials, taken in by 
way of food. But a second, and perhaps still 
more powerful cause, is motion.* There may 
be, and unquestionably are, many other subordi- 
nate causes which co-operate with these two, 
but as their power is probably much more limit- 
ed, we shall pass them over without any particu- 
lar notice, and at present only consider the effects 
of irregularities of the animal motions, which, 
we believe, will of themselves be found fully 
adequate to the production of putrescency, 



* Quamdiu asquabili motu per vasa circumducuntur humores s 
nulla nascitur in corpore putredo, omne illud, quod inciperet dispo- 
ni ad putredinem, solitis corporis viis e'liminatur, Vajv S vvietejv, 
Commentar, 



156 PATHOLOGY OF THE 

without the existence of putrid miasmata, or 
any other external power. 

That motion is one of the great and principal 
agents by which bodies or substances of various 
kinds are preserved from a state of putrescency, 
is a truth confirmed by daily observation ; and 
the reason of its being so strong and universal 
an antiseptic will perhaps more fully appear by 
a little attention to the phenomena that accom- 
pany bodies while putrefying. 

A great variety of repeated experiments and 
observations have demonstrated it to be an inva- 
riable law of nature, that an intestine, or as it is 
more usually styled, a fermentative motion must 
necessarily precede a state of putrefaction in 
dead animal and vegetable substances. But in 
order that this fermentative motion may more 
readily take place, it is necessary that the parts 
of the body upon which it is to operate, be in a 
state of repose among themselves ; for if they 
be put in motion by any external cause, or im- 
pelled by any vis a tergo, in the manner of the 
circulating fluids of the animal body, they will 
be much less susceptible of motion from any 



HUMAN FLUIDS. 157 

oilier cause, which, previously to its being able 
to operate upon them, must first overcome the 
motions impressed upon them #6 extra,or destroy 
the force by which they are already urged. 

Hence the greater purity of running water, 
and that of the sea when agitated by the winds, 
in comparison of the same when stagnating. 
The ocean is in a state of perpetual flux and 
reflux; and by this motion is it preserved fresh. 
It is only in marshes and some stagnating lakes 
that water is ever found putrid, according to the 
common expression ; for water of itself appears 
to be a non-putrescible substance, and it is only 
by being impregnated or mixed with other cor- 
ruptible matter that it actually becomes putrid. 

Since then it appears that a state of rest is 
favourable to putrefaction, and a state of motion 
unfavourable to it; and since it is certain that 
independent of the loco-motive faculty of a 
living body, all its various pads are in perpetual 
motion among themselves, we may very justly 
conclude, that motion is one of the causes of the 
preservation of the animal body from putrefac- 
tion during life, and the loss of this vital motion 



158 PATHOLOGY OF THE 

one of the causes of its destruction or corrup- 
tion after death. The blood is constantly per- 
forming the rounds of the circulation, which, 
when properly regulated, evidently possesses a 
power of preventing its putrefaction ;* yet this 
motion appears to be endowed with such a power 
only, in consequence of its enabling the vital 
fluid to throw off such matter as would corrupt 
it, if retained too long in the vessels ; and also 
by counteracting the fermentative motion, which 
is found to be absolutely necessary towards pro- 
ducing putrefaction in dead animal matter.f 



* On this subject, showing that the circulatory motion of the- 
blood impedes its putrefaction, the reader may consult Haller's 
Elementa Physiologic, torn. ii. lib. vi. sect. iii. ^ ix. et xiv. ; and 
also Dr. Alexander's Experimental Inquiry, to which able and 
interesting work, the author is particularly indebted for many ob- 
servations. 

f Si accuratius rationem exquisiveris, qua motus putredinem 
avertat, duplicem inveniemus. Nam progressivus motus intes- 
tino resistit, neque adeo sinit fermentationem obtinere, neque 
fere putredinem. Deinde vitalis motus sanguinis, organorumque 
sani hominis, huraores putrescibiles continuo expedit et abigit, 
et quae ad urinosam acrimoniam accedunt, ea per cutaneam per- 
apirationem, per urinam, cumque alvi fiecrbus expurgat et ejicit 
Haller, Elem. Physiol, torn. ii. p. S08. 



HUMAN FLUIDS. 159 

The blood and other juices will easily putrefy, 
either in the whole or any part of the body, by 
being entirely deprived of their accustomed 
motions.* If, for example, by a tight ligature 
or other means, the vital or circulatory motion 
of the blood be stopped in a leg or an arm, a 
mortification soon follows. The same thing 
frequently happens when from an internal ob- 
struction, the influent juices are denied admis- 
sion into any member or part of the body ; but 
in both these cases the most obvious cause is the 
loss of motion. In short, the tendency of the 
animal fluids to corruption or putrefaction will, 
ceteris paribus, be greater or less according to 
the degrees of motion impressed upon them by 
the heart and their contractile vessels. 

We have hitherto insisted upon the power of 
motion and antiseptic food, in retarding or 
counteracting the putrescency of the animal 
fluids ; but the motion all along alluded to is that 
called vital or involuntary, which must not be con- 



* Nam in toto humano corpore, et in singulo artu, continue 
liiimdres putrescant, quando motus suppresSus est. Halxer. 



160 PATHOLOGY OF ttlE 

founded with the intestine or fermentative ; the 
former tending to the preservation, and the lat- 
ter to the destruction of the animal body. But 
although the vital motions, when properly regu- 
lated, assist in preserving the humours from pu- 
trefaction, yet when they run to either extreme., 
they actually produce a contrary effect ; that is ? 
putrescency will be brought on by the circula- 
tion being rendered too slow,* or too rapid,f 
and thus the same effect will be produced by two 
directly opposite causes.J 

The circulation being too much retarded, the 
blood will be less able to throw off such excre- 



* Sublato motu progressive* sanguinis subita putredo nasci- 
tur. Haller, Elem. Physiol, torn. ii. p. 308. 

f Longe autem citius in putredinem abeunt humores anima- 
lium, si valide moveantur, si valido cursu, vel alio labore, quis 
corpus exercuerit. Quam olidus sudor, quam acris et fcetida 
redditur urina, dum febris acuta lactantem prehendit raulierem ? 
Nisi plurimum potet, intra paucas horas lac fiet tenue, subfla- 
vescens, salsum, odoris suburinosi. Van Swieten, Commen- 
tar. ^ 80. 

J Motus nulltis, et motus nimius liquidorum nostrorum, pro- 
ducunt putredinem ; sicque bin<e causae penitus opposite pro- 
ducunt eundem tffectum. Ibid. \ 84. 



HUMAN FLUIDS. 161 

mentitious matters as would corrupt it, if retained 
too long in the vessels ; whilst at the same time 
the constituent parts of this fluid will be more 
apt to fall into intestine or fermentative motions,, 
or to obey their respective attractive powers, by 
means of which they are brought into a state of 
corruption or putrescency. Hence it is that 
putrid symptoms so generally appear in the ad- 
vanced stages of all continued fevers ; for these, 
by quickly exhausting the strength of the vital 
or moving powers, dispose to sudden and uni- 
versal depression of strength, which, according 
to Dr. Fordyce,* constitutes the principal cause 
that determines the putrefactive tendency of the 
humours in fevers. But as debilitation, or de- 
pression of strength, produces putrescency of 
the fluids, so, on the contrary, putrescency of 
the fluids, in whatever manner produced, occa- 
sions depression of strength, and sometimes in a 
degree that proves fatal. 

How an excess of motion should also produce 
putrescency of the animal fluids is perhaps not 



* See his Third Dissertation on Fevers, part i. 
21 



162 PATHOLOGY OF THE 

easy to determine. It is probable, however, 
that it produces such an effect both by exhaust- 
ing the vital energies of the system, and by 
breaking down the texture of the vital fluid 
itself, or destroying the bond of union among 
its insensible particles, and depriving them of 
that plastic or cohesive principle, by the posses- 
sion of which the whole circulating mass is kept 
in its sound and natural state, and by the loss of 
which it degenerates into a morbid one. For, 
according to Beccher,* rarefaction or relaxation 
is the first effect of putrefaction. As an in- 
crease of temperature generally attends febrile 
action, it has been supposed that the putrescency 
of the humours might be owing in a great mea- 
sure to this increased heat.f But Dr. Sheb- 
beareJ affirms that the degree of animal tem- 
perature in putrid diseases, and particularly 
towards their last stages, is even less than that 
which naturally belongs to perfect health ; which 



* Beccher, Physica Subterranea. 
f Vide Clark, on Fevers, he. 
X Shebbeare, Practice of Physic. 



HUMAN FLUIDS. 163 

would appear completely to overthrow the 
Boerhaavian* doctrine of heat being the cause 
of putrefaction. But be this as it may, it is cer- 
tain that violent febrile motion has frequently 
produced a putrid diathesis of the blood and hu- 
mours, in the short space of one or two days.f 
The same thing happens from vehement exercise 
or muscular moiion.J The flesh of animals run 
to death quickly putrefies. § 

From what has been said above on the effects 
of motion and rest applied to the animal body, 
the conclusion appears obvious that putrid symp- 
toms may arise either from a defect or an excess 



* Vide Boerhaave, Elem. Chem. torn. i. cap. De Igne, Ex- 
per. xx.Coroll. 16. 

f Nimia agitatio longe adhuc celerius putredinem inducit. 
Acutissima febris intra 24 horas sic potest corrumpere omnia, 
ut urina fcetida, fasces alvinx cadaverosse penitus, halitus oris 
putridissimus, interna omnia jam corrupts testentur. Vaj? 
Swieten, Commentar. \ 84. 

\ Corporis vehementior exercitatio sola, uriuam fcetidam, 
acrem, urentem reddit, sudorem ingratum nidorem olentum, 
sanguinem acrem, febresque omnium ardentissimas, et subilas 
mortes. Haller, Elem. Physiol, torn. ii. p. 34. 

^ Ibid. p. 85. 



164 PATHOLOGY OF THE 

of the vital motions. Of consequence, what- 
ever causes such defect or excess will have a 
tendency to bring on a putrid disposition of the 
fluids. Putrid diseases, therefore, may be gene- 
rated in the individual without the agency of 
miasmata, or any other cause ah extra;* for the 
animal body, having in itself a constant tendency 
to, and possessing in an eminent degree the ne- 
cessary requisites for putrefaction, will spontane- 
ously run into that state, whenever the causes 
that perpetually obviate or counteract this dis- 
position shall be suspended or taken away. 

Such putrid diseases as involve the whole 
system, may arise either from a too rapid, or 
too languid circulation ; from the use of un- 
wholesome aliments, or an insufficient quantity 
of nourishment; from the suppression of per- 
spiration ; or from the introduction of contagion 
or putrid miasmata. 



* Though it is stated above that putrid diseases may be gene- 
rated in the individual without the aid or co-operation of conta- 
gion, it is not thereby intended to preclude its agency in this 
respect, as these disorders may be, and undoubtedly are, also 
caused by it 



HUMAN FLUIDS. 165 

As to the peculiar manner in which miasmata 
produce putrid symptoms, whether it be by first 
contaminating the juices, and assimilating them 
to their own corrupt nature ; or whether they 
possess sedative properties by which they weak- 
en or paralize the moving powers, and thus 
have a tendency to produce putrefaction; or 
whether, on the contrary, being received into the 
blood, they act as stimuli in exciting the heart 
and arteries to more frequent and forcible con- 
tractions, thereby hurrying on the circulation in 
such a way as to promote a dissolution and pu- 
trescency of the fluids, it is not easy to deter- 
mine, nor is it our business particularly to in- 
quire. 

The putrid miasmata, which infect our atmos- 
phere, may not improperly be divided into 
vegetable, animal, and vegeto-animal. Marsh 
miasmata, or the effluvia arising from marshes, 
lakes, and stagnating waters of all kinds, where 
a variety of dead vegetable and animal sub- 
stances are putrefying together, are universally 
allowed to be the cause of intermittents in all 
countries. In those countries, too, where such 



166 PATHOLOGY OF THE 

intermittents are common, continued fevers not 
unfrequently appear in the autumn, which may 
be easily accounted for by the atmosphere being 
at that time more generally loaded with noxious 
and putrescent vapours, which arise from the 
decomposition of large quantities of decayed 
animal as well as vegetable matter.* That the 
diseases arising from this source frequently as- 
sume more or less of a putrid cast, appears to be 
established on the concurrent testimony of the 
most distinguished practitioners. The expe- 
riments of the sagacious Dr. Alexander,! 
however, render it probable that such mias- 
mata are the cause of putrid diseases much less 
frequently than has been generally imagined. 

But the putrefaction of vegetables is gene- 
rally supposed to be less noxious than that of 
animals.J Animal effluvia may be divided into 
two kinds. First, that which proceeds from dead 
animal bodies of any sort passing through the 



* Vide M'Cregor, Medical Sketches. 
f Alexander, Experimental Inquiry. 
I Prikgle, Diseases of the Army. 



HUMAtt FLUIDS. 167 

natural process of putrefaction in the open air, 
as sometimes happens from the accidental de- 
struction of large quantities of frogs, fish, 
reptiles, insects, and a variety of other animals 
which multiply in such surprising numbers, par- 
ticularly in warm climates ; or from the prodi- 
gious slaughter occasioned by bloody battles 
between numerous armies. Secondly, that 
which arises from the exhalations from diseased 
or even sound bodies when closely crowded to- 
gether in confined and ill ventilated apartments, 
as in jails, barracks, military hospitals, or the 
holds of transport ships. The malignant or 
highly infectious quality of this latter, which 
may not improperly be denominated animal con- 
tagion, as distinct from specific morbid conta- 
gion, is familiarly known. 

Almost every writer, both ancient and modern, 
in enumerating the various causes of putrid epi- 
demics, has reckoned the effluvia emanating from 
putrid animal matter as one of the most com- 
mon. It is probable, indeed, that this kind of 
matter may have sometimes produced such an 
effect, yet if we were thoroughly to examine 



168 PATHOLOGY OF THE 

the subject, it would perhaps be found to be the 
case much less frequently than has been gene- 
rally imagined, and then, too, chiefly in the more 
sultry and less ventilated parts of the globe. In 
our northern climate, as well as in most Euro- 
pean countries, the atmosphere is so changeable 
and so constantly agitated by frequent and some- 
times violent winds, that no kind of putrid ex- 
halations can long enough remain stationary in 
the open air, to be exalted into a degree of vi- 
rulence capable of producing general infection, 
and much less of acquiring a pestilential influ- 
ence,* before it is dispersed and swept away by 
violent or sudden gusts of wind. When, indeed, 
such exhalations are confined to a very limited 
space, and there concentrated and deprived of 
all chance of escaping, they may easily acquire 
a virulence capable of producing putrid and 
very fatal distempers, though they do not arise to 
the malignity of the true plague. 



* No kind of putrefaction is ever heightened in these Euro- 
pean countries to a degree capable of producing the true plague. 
Mead, on the Plague. See also Bla>e, Diseases of Seamen, 



HUMAN FLUIDS. 169 

But although we, who inhabit the colder and 
better ventilated parts of the world, have little 
reason to dread a putrid contagion being gene- 
rally diffused through the atmosphere, so as to 
contaminate any considerable region of it; yet 
are we assured that it has often infected indivi- 
duals who have either come into actual contact 
with it, or unintentionally approached too near 
it, when in a confined and highly concentrated 
state. Neither are we to infer that all parts of 
the world are equally exempted from the influ- 
ence of this effluvium. In many hot climates, 
where an uninterrupted calm almost perpetu- 
ally reigns, the exhalations arising from animal 
putrefaction may accumulate in prodigious quan- 
tities, and remain undisturbed in the atmosphere 
till it is heightened by the heat of the sun into 
the most malignant qualities; and gradually 
contaminating surrounding objects, it is propa- 
gated from one to another, till it spreads to a 
considerable distance, tainting every thing in its 
way, and loading the atmosphere itself with the 
semina of disease and death. The propagation 
of such an infectious atmosphere is beautifully 

22 



170 PATHOLOGY OF THE 

described in a passage of Lucretius, De Rerum 
Natura, which has, on a similar occasion, been 
quoted by Dr. Hosack : 

Proinde, ubi se coelum, quod nobis forte venenum, 

Conmovet, atque aer inimicus serpere coepit ; 

Ut nebula ac nubes, paullatim repit, et omne, 

Qua graditur, conturbat, et inmutare coactat. 

Fit quoque, ut in nostrorum quom venit dinique coelum., 

Conrumpat, reddatque sui simile, atque alienum. 

Luc. lib vi. v. 11 17, 

But when the heaven, of poisonous power to us. 
First moves remote, its hostile effluence creeps 
Slow, like a mist or vapour ; all around 
Transforming as it passes, till, at length, 
Reach'd our own region, it the total scene 
Taints, and assimilates, and loads with death. 

Good. 

But after all it may be much questioned 
whether mere putrefaction, or the effluvium of 
putrid and decomposed animal and vegetable 
matter, is not very distinct from the gaseous and 
subtle matter constituting a specific contagion ; 
more especially when we consider that the lat- 



HUMAN FLUIDS. 171 

ter always produces the same peculiar and spe- 
cific affection ; whereas the diseases proceeding 
from the former source have been generally 
observed to assume great diversity of character. 
Dr. Chisholm, whose works will stand as lasting 
monuments of learning and medical science, is, 
after much inquiry and reflection, as he tells us, 
fully convinced, that the product of animal pu- 
trefaction never acquires a pestilential influence ; 
i. e. that it is, under any circumstances, wholly 
inadequate to the production of pestilence, or 
the true plague, for which it has been so gene- 
rally censured.* This distinguished philoso- 
pher is of opinion, that the effluvia from dead 
animal bodies, passing through the natural pro- 
cess of putrefaction, when applied in a concen- 
trated state to the bodies of living animals, may 
act as poison, producing in the living animal 
frame, fever, perhaps, but incommunicable, or 
incapable of propagation by contagion.f 



* Chisholm, on Contagion, in the Edinburgh Medical and 
Surgical Journal. 1810. 
f Ibid, toe, cit.^ 



372 PATHOLOGY OF THIS 

But although the diseases produced by animal 
putrefaction never arise to the malignity of a 
true plague, the evidences are too numerous and 
too strongly supported to doubt that it has often 
produced putrid, or fatal distempers in particu- 
lar bodies exposed to its action, and sometimes 
perhaps even putrid epidemics, particularly in 
hot, or tropical countries.* 

Tt seems also to be an established position, that 
in proportion to the foulness of a place, or 
rather to the quantity of putrid vapours float- 
ing in its atmosphere, it will be more or less 
subject to pestilential fevers, or to receive and 
multiply the leaven of a true plague introduced 
into it either by merchandize or other means. 
Contagious and pestilential fevers appear to be 
always rendered more malignant in a foul than a 
pure atmosphere. The facility, too, with which 
they are communicated through the medium of 
a vitiated atmosphere, and the rapidity with 
which they are propagated would seem to war- 
rant the idea, that the air surrounding the sick 

* Vide Forestus, Mead, Pringle, Lind, Biane, be. 



HUMAN FLUIDS. 17$ 

becomes assimilated to the nature and character 
of the specific virus emanating from their bodies,, 
by which means the poison is both multiplied and 
more widely diffused, so as greatly to increase 
the chance of communication to other persons. 
The malignity and increased mortality attending 
the plague of Athens,* and the pestilential 
fever of Rome,f u c. 289, would appear to have 
been owing principally to the great filth occa- 
sioned, not only by other circumstances, but 
more particularly by the great crowds of people^ 
and by the large number of cattle of every 
description brought in for shelter from the coun- 
try. This circumstance, attending the propa- 
gation of fevers communicable by a specific 
contagion, has been most ably and clearly illus- 
trated by Dr. Hosack, in his letters to Dr. 
Chisholm, on the subject of contagion. Speak- 
ing of the laws which govern the communication 
and propagation of plague, yellow fever, malig- 
nant dysentery, and the various forms of typhus, 



* Vide Thuctdides, lib. ii. ; Diod. Sictlus, lib. xiL cap. 14, 
f Livy, Hist. Rom. lib. iii. cap. P. 



174 PATHOLOGY OF THE 

Dr. Hosack remarks, that " these diseases are 
only in general communicable through the me- 
dium of an impure atmosphere : in a pure air, 
in large and well ventilated apartments, when 
the dress of the patient is frequently changed, 
all excrementitious discharges immediately re- 
moved, and attention paid to cleanliness in ge- 
neral, these diseases are not communicated, or 
very rarely so, from one to another. But in an 
impure air, rendered so by the decomposition of 
animal and vegetable substances, as takes place 
in low marshy countries, or by concentrated hu- 
man effluvia, as in camps, jails, hospitals, or on 
ship-board, they are rendered not only extreme- 
ly malignant and mortal in themselves, but be- 
come communicable to others who approach the 
sick, or breathe the same atmosphere, which has 
become assimilated to the poison introduced, in 
so much, that the same specific disease is commu- 
nicated, whether it be the plague, yellow fever 9 
typhus, or dysentery"* 



* Vide Amer. Med. and Philos. Register, vol. ii. ; and also the 
Edinburgh Medical and Surgical Journal. 1809. 



HUMAN FLUIDS. 175 

Particular states of the atmosphere also fa- 
vour the production of putrid diseases. This 
invisible fluid, it is well known, is constantly and 
indispensably necessary to animal life; and as 
we are perpetually in contact with, or surround- 
ed by the same, and likewise swallowing it mixed 
with our aliments, as well as inhaling it every 
moment of life into the lungs, it is plain that 
the air itself, and of consequence any contagion 
or impurities inherent therein, may easily enter 
the body in considerable quantities, so as to pe- 
netrate every part of it. For this, as well as for 
other reasons, it has always been customary to 
consider a pure and wholesome air as one of the 
greatest sources of health, and its various changes, 
or impurities, one of the most frequent causes of 
disease.* Agreeable to which, whenever putrid 
diseases have become epidemic, and no visible 



i* Toleri eTg £,v &vnra!i<rtv outoc (scil. o 'A;jg) «.«'<nos touts 0iov, nut 
•rw voaiicv Tctai voa-'tova-i. MiTtt touts toiVuv, euSsaif p»Teov, 'in iun- 

ahhoQiv 7roBiv uko; i?t yiviT%a,t tcls e£ppas4at fx^LKira.-, » IvtsuSsv ot«.v 
tou7o n 7t\mv, n iKittreroV) n icau st'S-goaiTsgov, khi fxi/um'T/j.ivov vottepiqn 
y.tcl<ry.a.<rtv t'ct to iru/** \<rt'h&k, * Hippocrates, JDe Flatibus. 



176 i'ATHOLGGY OF THE 

or manifest cause could be assigned, they were 
said to depend upon certain occult, or, as they 
were sometimes denominated, malignant quali- 
ties of the atmosphere. Hippocrates* affirms 
that the air alone is the author and cause of all 
epidemic or pestilential diseases ; and the reason 
why they happen to all indiscriminately, is that 
all breathe the same air in common. 

But notwithstanding the frequent opportuni- 
ties that physicians have had of witnessing the 
rise, progress, and declension of putrid, pestilen- 
tial, and epidemic diseases in different parts of 
the world, we are to this day ignorant of their 
real cause. No medical subject, perhaps, is less 
thoroughly understood, or involved in greater 
obscurity. For so various are the natures or 
character of epidemics, even when the seasons 
and weather have appeared to be exactly the 
same, that the celebrated Sydenham, who had 
paid more than ordinary attention to this subject, 



* 'O (MSV OVV K0t\0i ^t/gST0?j SlU, TOVTO TCtOVTCig £S"/V, OTl T8 WlV/UlCt 
TteVTO TTtLVTiS iXX.0V/7lV OlJ.oibd Si O/UOlCeC TOU WiU/HStTOi Ttt> Ctf/ACLTl 

jw.i^Bivrog, oftoiot nan 01 7rv£not ywovp&t. Hippocrates, De Fla- 
tibus. 



HUMAN FLUIDS. 177 

did not hesitate to declare, that although he had 
carefully attended to the manifest qualities of 
the air, he had made no progress in discovering 
the causes of epidemical diseases; having re* 
marked, that in different years, which perfectly 
agreed as to the manifest temperature of the air, 
the prevailing diseases were very different, and 
vice versa : so that he was led to conclude that 
they depended upon some secret or invisible 
quality in the air, which we have not yet, and 
perhaps never shall be able to obtain the smallest 
knowledge of.* But notwithstanding that we 



* Quamvis autem diversas diversorum annorum habitudines s 
quoad manifestas aeris qualitates, maxima qua potui diligentia 
notaverim, ut vel exinde causas tantas epidemicorum vicissitudi- 
nis expiscarer, ne tamen ne hilum quidem hactenus promoveri 
sentio ; quippe qui animadverto annos quoad manifestam aeris 
temperiem sibi plane consentientes, dispari admodum morbo- 
rum agmine infestari, et vice versa. Ita enim se res habet 
Vari<e sunt nempe annorum constitutiones, quje neque calori, 
neque frigori, non sicco humidove ortum suum debent ; sed ab 
occulta potius et inexplicabili quadam alteratione in ipsis terra 
visceribus pendent, unde. aer ejusmodi effluviis contaminatur. 
Sydenham, De Morb. Ejpidem. cap. ii. 

23 



178 PATHOLOGY OF THE 

are unable to discover all, or any of the hidden 
qualities of the atmosphere, there can be no 
doubt of its manifest qualities having a conside- 
rable share in the production of epidemic dis- 
eases, though they may not be able to produce 
them without the assistance of some other 
causes. 

Heat and moisture are well known to be the 
necessary and most powerful causes of putrefac- 
tion. Agreeable to this, it has been found from 
experience, that a continuation of warmth and 
humidity in the atmosphere has generally been 
succeeded by some epidemic of the putrid kind ; 
such as plagues, or pestilential fevers in south- 
ern, and intermittents, dysenteries, and malig- 
nant fevers, in northern regions. This is the 
pestilential disposition of the air described by 
Hippocrates,* and by many succeeding physi- 
cians. We are informed by Dr. Mead, that the 
plague usually invades ^Ethiopia whenever rains 
fall during the sultry heats of July and Au~ 



ft Pe Morb. Yulg. lib. iii. 



JIUMAN FLUIDS* 179 

gust.* On the contrary, they have generally 
been observed to abate something of their viru- 
lence and progress, or sometimes entirely to 
cease, on the emendation of this state of the air. 
In Egypt and the Barbary States, as we learn from 
Prosper Alpimts,! and others, the plague always 
breaks up in the summer months, at which time 
the weather in these countries is hot and dry. 
But the progress of pestilential fevers is more 
certainly impeded by a cool dry air ; and frosty 
weather, or the settled cold of winter, almost 
always extinguishes this form of disease. In 
the several visitations of the yellow fever, (the 
malignant pestilential fever of Dr. Chisholm,) 
in the city of New-York* this disease has invari- 
ably disappeared at the approach of winter.^ 

These several circumstances attending the rise, 
progress, and declension of putrid epidemics, 
afford the strongest proofs of a warm, humid 



* Mead, on the Plague, chap i. 

f Prosper Alpinus, De Medicina iEgyptorum, lib. i. 

X Hosack, MS. Notes on the Theory and Practice of Physic 
and Clinical Medicine ; Amer. Med. and Philos. Register ; 
Hardie, Account of the Malignant Ferer. 



180 PATHOLOGY OF THE 

atmosphere being favourable to diseases of a 
putrescent character ; though it may be much 
doubted whether of itself it be able to produce 
such an effect without the concurrence or co- 
operation of some other cause or causes. Heat 
and moisture are both of them powerfully relax- 
ing and debilitating to the whole animal system ; 
their principal efficacy, therefore, probably lies 
in rendering the body more obnoxious to the in- 
fluence of a putrid infection of any kind, which, 
w 7 hen applied, will in such a condition of the at- 
mosphere easily produce a putrid disorder; 
whereas, had the air been warm and dry, or cold 
and dry, perhaps no such effect would have fol- 
lowed. Contagion or impurities of any kind 
are also more difficultly and slowly dispersed 
through a moist, than through a dry atmos- 
phere. 

Next to the warm humid, the cold humid 
state of the atmosphere appears to be most con- 
ducive to the origin of putrid diseases; with 
this difference, perhaps, that the former contri- 
butes most to the rise and progress of acute 
putrid disorders, as malignant and pestilential 



HUMAN FLUIDS. 181 

fevers of every kind ; and the latter to slow and 
chronic ones, as the scurvy, frc. The cold 
humid atmosphere, it is true, is not so favourable 
to the putrefaction of dead animal matter, be- 
cause heat as well as moisture, is requisite; but 
the living body has naturally and constantly 
within itself a temperature sufficient for this 
process, and therefore requires not the aid of 
external heat. These things considered, it be- 
comes difficult to decide whether a warm humid, 
or a cold humid state of the atmosphere may be 
most favourable to diseases of a putrescent 
nature.* 

A cold and moist constitution of the air ap- 
pears to favour the production of putrescency 
in the living body, chiefly in two ways. First, 
by obstructing perspiration, and filling the ves- 
sels with a superfluous load of noxious and pu- 
trescent juices, by which the body will be ren- 
dered more subject either to fall into spontane- 
ous corruption, or to receive the infection of a 
putrid disease of any kind. And secondly, by 



* Alexander, Experimental Inquiry. 



182 PATHOLOGY OF THE 

relaxing the fibres, and impairing the elasticity 
of the animal system; thereby diminishing the 
strength of the moving powers, and of conse- 
quence producing a languid state of the vital 
motions, and a greater incapacity in the body 
itself to resist any morbid contagion which may 
be applied to it. 

Whatever shuts up the pores of the body, and 
impedes or lessens the cutaneous and pulmonary 
perspiration, (which moisture or dampness gene- 
neraily does, and that more effectually when 
conjoined with cold,) will have a tendency to in- 
crease the putrid diathesis of body. Cold 
joined with dryness and purity in the atmos- 
phere, by keeping up a due tension in the solids,, 
is naturally productive of diseases of the acute, 
or inflammatory kind. But in a cold moist state 
of the air, all acute and inflammatory diseases 
will be more apt to assume a putrid tendency. 
The peripneumonia typhodes, which has lately 
prevailed in several districts of the United 
States, and which has been generally terminated 
at the approach of warm weather, is a disease of 
this mixed or compound character, consisting in 



HUMAN FLUIDS. 183 

a local inflammation of the lungs conjoined with 
a putrescent or typhoid tendency of the whole 
body.* 

After this attempt towards investigating the 
principal causes of putrid diseases, and their 
manner of operating upon the human body, it 
might seem proper to say something concerning 
the method of curing them. But from this 
we are necessarily prevented. The reader 
will find this subject most ably treated by 
Dr. Huxham and Sir John Pringle. From 
what has been said, however, relating to 
the causes of putrescency in the living body, 
it is plain, that one of the great and principal 
means of obviating such a condition of body, is 
to support the energy and activity of the living 
principle. The vital motions are to be preserved 
as near as possible to their natural standard, by 
endeavouring to raise and support them when 
they become too languid, and to curb them when 
they have a tendency to run too high. 

* Vide Hosack's Letter to Dr. Beck, in the Amer. Med. anxl 
Philos. Register, vol. iii. p. 443. 



1^4 PATHOLOGY OF THE 

Action of Specific Morbid Poisons. 

In what manner does the specific matter of a 
contagious disease act on being received into 
the mass of blood ; what parts of the human 
body are more especially the seat of its opera- 
tion, and what are the changes effected by its 
action ? 

The peculiar kind of action by which specific 
contagions produce the various changes from a 
healthy to a diseased state, being a process imper- 
ceptibly carried on in the system, and not ob- 
vious to our senses, we can only pronounce on 
the nature of that action by the visible effects 
that are produced. These effects, though nu- 
merous, appear to depend chiefly upon an alter- 
ed and contaminated state of the animal fluids; 
from which source all the other parts of the 
body may become affected. The analogy, there- 
fore, of a ferment, or rather of an assimilatory 
process, in the fluids, seems most consonant to 
the phenomena accompanying the operation of 
specific contagions. 



iltiJlAN FLUIDS. 185 

In the application of this term to the living 
buman body we are warranted by the authority 
of several modern writers of eminence. " It is 
evident," says Dr. Cullen, " that the contagion 
of the small pox acts as a ferment with respect 
to the human fluids, and assimilates a great part 
of them to its own nature."* Mr. Crcikshank 
is decidedly of opinion that a process of this kind 
may take place in living matter. " Fermen- 
tation," says he, " has been chiefly observed in 
dead matter, and is commonly accompanied 
with ebullition and extrication of air ; but fer- 
mentation may also take place, and I believe 
certainly does take place, in living matter. Ebul- 
lition, or any evident motion, is not necessary 
to constitute fermentation; after wine has un- 
dergone what is called its open fermentation, it 
continues, after it is bottled, to go through its 
secret fermentation, where no motion is evident, 
and every body knows requires time to ripen. 
All that is necessary in fermentation is, that the 
elementary particles be separated and recom- 



* Cwli/bw, First Lines, vol. i. ^ 597. 
24 



186 PATHOLOGY OF THE 

bined, so that the matter be converted into some- 
thins different from what it was before."* The 
sagacious and practical Dr. Walker remarks, 
that he is for many reasons " inclined to believe, 
that the noxious contagious matters of small pox, 
after making their way into the circulation, do 
there act as ferments, and assimilate some con- 
stituent parts of the blood into their own cor- 
rupt natures."! Mr. Benjamin Bell gives it as 
his opinion, "that the matter of all contagious 
diseases has a power of assimilating to its own 
nature a certain portion, and ultimately, perhaps, 
the whole fluids of the body ."J Dr. Francis, 
in his able and interesting paper on Mercury, 
has the following observation; "that certain 
specific morbid matters, when introduced into 
the system, do assimilate to their own peculiar 
nature the human fluids, though often in a gra- 
dual and always imperceptible manner, is still 
very obvious to the senses, from its effects in 
cases of variolous infection, and in other diseases 

* Cruikshank, Anatomy of the Absorbing Vessels, p. 111. 

f Walker, on Small Pox, p. 69. 

% Bell, on the Venereal, vol. ii, p. 164 



HUMAN FLUIDS. 187 

of specific contagion."* Were further autho- 
rity necessary on this subject, we might add to 
the above the names of Dr. SiMs,f Dr. Hosack,^ 
and other distinguished modern physicians. 

Doubts have, notwithstanding, been entertain- 
ed whether any operation of this kind could 
occur in the fluids during their circulation. The 
most sceptical, indeed, acknowledge that conta- 
gious matter of any kind, when " lodged in the 
cellular texture, or other similar situation, will 
ferment and assimilate the surrounding humours 
to its own nature ;" but when it passes into the 
circulation, say they, such a process cannot well 
be conceived to take place, because, forsooth, 
that degree of rest which appears to be requi- 
site to every fermentative process, does not 
there obtain. It may, indeed, be difficult to 
conceive how a true fermentation can go on in 



* Francis, Inaugural Dissertation on Mercury. 

| Sims, Sketch of a New Theory of Cow Pock, with Re- 
marks on Contagious Disorders ; published in the Memoirs oi* 
the Medical Society of London. 

| Hosack, MS. Notes on the Theory and Practice of Physic 
and Clinical Medicine* 



188 PATHOLOGY OF THE 

fluids in circulation. But surely it cannot from 
thence be argued that a material of the active 
and penetrating nature of contagion, would lose 
its influence merely because it is inconstant mo- 
tion. Contagious matter of any kind, when 
transmitted into the circulating mass, instead of 
rolling on in a friendly conjunction therewith, 
must necessarily mix and unite with some of 
the constituent parts of the blood, to which it 
will communicate its infectious qualities, and 
these again, while moving through the vessels, 
will more easily come in contact with other parts 
of the blood, which may in like manner become 
contaminated. Moreover, some of the contagious 
particles being arrested in the smaller vessels, 
will there ferment and assimilate the surround- 
ing juices to their own nature ; and these being 
absorbed, or again returned into the circulation, 
will increase the infection till a considerable 
portion, and ultimately, perhaps, the whole 
fluids of the body shall become assimilated to 
the nature of the contagious virus introduced. 

The doctrine of ferments delivered in medi- 
cal writings has, very probably, like many 



HUMAN FLUIDS. 189 

others, been carried to excess ; but this, surely, is 
not a sufficient reason for denying the possibili- 
ty of our fluids being susceptible of being acted 
upon by a ferment. This term, it must be ac- 
knowledged, as applied to express the peculiar 
action of contagion upon the animal fluids, is 
liable to objections, inasmuch as that action 
does not in all respects exactly correspond with 
the process from which the analogy is taken. 
There can, however, be no formidable objection 
to Jhe use thereof, provided it be properly ex- 
plained, or received in a qualified sense, as ex- 
pressive merely of an assimilatory process, or 
one analogous to fermentation, by means of 
which, some of the constituent parts of the blood 
and other humours are so altered or changed in 
their character and properties, as to approximate 
to the nature and qualities of the specific conta- 
gious virus operating upon them. The blood, 
unquestionably, is unsusceptible of an acetous 
fermentation, or of an action like that which 
takes place among vegetable substances. But 
the visible effects produced, and particularly 
the evident multiplication and accumulation of 



190 PATHOLOGY OP THIS 

contagious particles generated in this fluid, in 
those diseases produced by the introduction of 
a specific contagion, as in small pox, measles, 
plague,* &c. are evidence sufficient for styling 
the process, by which such multiplication of in- 
fectious matter is accomplished, an assimilating 
fermentation,! though we are unable to give 
any precise explanation of the manner of its 
action. It is only by their effects that we be- 
come acquainted with many of the operations 



* Notwithstanding the assertions of modern sceptics to the 
contrary, it is now very satisfactorily ascertained that the 
plague is a specific contagious disease ; and, like small pox or 
measles, is not only communicable through the medium of the 
air, but also by inoculation. For facts on this head, see the case 
of Dr. Whtte, (who fell a victim to his own rashness and in- 
credulity,) recorded in Desgenettes, Histoire Medicale de 
1'Armee de 1'Orient ; also Sonnini's Travels in Egypt, &c. and 
Wittman's Travels, &c. 

| We have been thus particular in restricting the sense of the 
term ferment, as applied to the living body, lest it might be sup- 
posed, that we were endeavouring to revive the ancient and 
justly exploded doctrine of a fermentation of the blood like 
that which happens among vegetable matter, than which nothing 
indeed could be more opposite to our intention. 



HUMAN FLUIDS. 191 

of nature. Who will venture to define the pre- 
cise manner in which the different changes take 
place in substances going through the process of 
fermentation. " The chemist can only show us 
what is produced by fermentation ; but the most 
skilful in that art has never attempted to explain 
the mode of its operation, even in dead matter ; 
far less can any satisfactory account be given of 
its operation in the living animal." 

That the animal fluids become morbidly af- 
fected, in diseases of specific contagion, or are 
assimilated to the nature of the peculiar virus 
introduced into them, receives support not only 
from the multiplication of the infectious mate- 
rials throughout the system, but is further 
strengthened by the communication in every 
instance of a disease of the same specific cha- 
racter with the original of the infectious matter 
introduced ; by the conversion of a local affec- 
tion into a general or constitutional one ; and 
by the production of new and similar matter 
in different and remote parts of the body, when 
the infection has been only locally applied, as is 
observable in the production of pustules over 



192 PATHOLOGY OP THE 

the whole body, in inoculated measles, small 
pox, &c. A portion of the matter of any of 
the contagious disorders is received into the 
living human body, and a disorder of the same 
kind with its original is produced, and no other. 
If the matter has been locally applied, as in inocu- 
lated small pox, a local affection is produced, 
which is ultimately succeeded by a general one, 
and the occurrence of pustules on various and 
remote parts of the body ; but all of them filled 
with matter of the same specific nature with 
that generated in the part where the virus was 
first locally applied. Previously, however, to 
the production of general symptoms, a certain 
portion of the contagious matter must be re- 
ceived into the general circulation, and convert 
more or less of the fluids to its own nature, 
which process may be quick or slow in its pro- 
gress, according to circumstances ; but as long as- 
the quantity of matter assimilated is inconsider- 
able, no marks of general disease will be pro- 
duced, nor will the constitution show the effects 
thereof till the virus has had sufficient time to 
multiply and accumulate in such quantities as to 



HUMAN FLUIDS. 193 

be capable of exciting some degree of morbid 
irritability in the solids, or in the living princi- 
ple. 

But the most satisfactory, not to say demon- 
strative evidence of the fluids becoming mor- 
bidly affected in contagious disorders, is, that the 
blood and other humours of persons labouring 
under certain of the contagious disorders, are 
capable of communicating the same disease to 
others, whose constitutions are in a condition 
susceptible of infection. This is a fact which 
those who suppose that the cause of disease is 
never seated in the fluids are necessarily obliged 
to deny. They are forced to say, that the blood 
in contagious diseases always remains perfectly 
sound, and that neither this fluid, nor any of the 
secretions derived from it, are capable of infect- 
ing others ; an assertion without the least foun- 
dation, and disproved by almost daily expe- 
rience. The experiments of Dedier and Cou- 
zier prove that the blood and bile are morbidly 
infected in the plague.* It is also well known, 

* Vide Pbilos. Trans, vol. vii. Abridg. 
25 



194 PATHOLOGY OF THE 

that Dr. Francis Home practised the inocula- 
tion of measles with the blood of morbillous 
patients in several instances with complete suc- 
cess.^ The communication of small pox to the 
foetus in utero, is inexplicable on any other 
ground, except by supposing that the maternal 
blood is in a morbid state, and more or less as- 
similated to the nature of the variolous conta- 
gion : for the circulation through the umbilical 
cord being the only free and direct communica- 
tion between the foetal and maternal systems, the 
blood is the only medium through which the 
unborn infant can receive, and participate in, any 
of the diseases of its parent. 

That the foetus in utero is sometimes infected 
with small pox, is a fact established as the result 
of much experience and observation. Dr. George 
Pearson has collected many well-authenticated 
cases of this kind from different authors ; and 
also relates one which fell under his own personal 
noticcf Two instances of the small pox af- 



* Home, Medical Facts and Experiments. 

t See Duncan's Medical Commentaries, vol. sax. 



HUMAN FLUIDS. 195 

fecting the foetus in utero are recorded by Dr. 
Mead.* Dr. Hosack has related two cases of 
the same kind that occurred in his own practice 
while resident at Alexandria, in Virginia.! A 
case is related by Mr. Turnbull, of a lady who, 
in the seventh month of her pregnancy, was in- 
oculated, and went through the regular small 
pox. Nine days after the eruption she was de- 
livered of a dead child covered with pustules, 
that proved to be variolous from its communi- 
cating the small pox to several persons who were 
inoculated with some of the matter.J In the 
case recorded by Mr. Lynn, the child, at the time 
of its birth, was covered all over its body with 
distinct pustules, which, however, were not com- 
pletely filled till three days after, at which time 
a little matter taken from one of them commu- 
nicated the disease to another child that was in- 
oculated with it.$ Other and similar cases of 



* Discourse on the Small Pox and Measles. 
f Duncan's Medical Commentaries, vol. xix. 
X Memoirs of the London Medical Society, vol. iv. 
v> DuNCAPj's Medical Commentaries, vol. xix. 



196 PATHOLOGY OF THE 

uterine small pox have been recorded by 
Bland,* Derham,! Roberts,^ Haygarth,§ Bur- 
seriuSjII Laird,1[ Forbes,** JENNER,tt &c 

It is also well known, that mothers labouring 
under the venereal disease in a constitutional 
form may, and not unfrequently do, communi- 
cate the disorder to the foetus in utero : and the 
ulcers, too, which sometimes occur in the mouths 
of children born of such infected mothers, have 
been known to produce the same disease upon 
the nipples of women by whom they were 
suckled ; nay, these women have communicated 
it to other children, and these children again to 
other nurses. It 



* London Medical Journal, vol. ii. 
f Philos. Trans, vol. v. Abridg. 

j Medical Journal, vol. v. 

^ On the Small Pox. 

jj Institutions of the Practice of Medicine, vol. iii. 

Tf Edinburgh Medical and Surgical Journal, vol. iii. p. 155. 

"** Edinburgh Medical and Surgical Journal, vol. iii. p. 307. 

ff Med. and Chirurg. Transactions, vol. i. 

# Vide Bell, on Gonor. Virul. and Lues Ven. vol. ii. ; Un- 
derwood, Diseases of Children ; Mahof, on the Ven. Infect, 
in Pregnant Women. 



HUMAN FLUIDS. 197 

A healthy child may receive the venereal 
affection by sucking an infected nurse, of 
which two remarkable cases fell under the ob- 
servation of Dr. Hosack; which satisfactorily 
prove, that not only the blood, but also the se- 
cretions derived from it, are capable of commu- 
nicating venereal affections. We may also re- 
mark, that one of the infants which had been 
thus infected produced the same disease upon 
the nipples of another nurse by whom it was 
suckled.* 

From all that has been said upon the present 
subject, it appears most just and rational to con- 
clude, that the specific morbid poisons of the 
different contagious disorders act primarily and 
more especially upon the animal fluids, in con- 
verting and assimilating them to their own cor- 
rupt and infectious qualities ; and that the solids 
are chiefly and ultimately affected in a secondary 
way only, being excited by this morbid state of 
the fluids to some degree of unusual or inordi- 



* Hosack, MS. Notes on the Theory and Practice of Physic 
and Clinical Medicine, 



198 PATHOLOGY, &C. 

nate exertion, which is uniformly productive of 
various morbid phenomena, according to the 
peculiar kind of virus, the state of the consti- 
tution, and the condition of the living principle 
itself. 



ON 



THE MORBID QUANTITY 



OF 



THE FLUIDS. 



As it respects the quantity of circulating fluids 
in the human body, they may become the source 
of disease either through excess or deficiency ; 
which constitute the ttom^v^* and i^t^u of 
pathologists. A paucity or mere deficiency of 
healthy fluids seldom happens, except from some 
copious and sudden evacuation, or from famine ; 
nor can it be long sustained without being at- 
tended with a vitiated quality, from the debility 
or prostrated vigour of the functions. A defect 
in the quantity of fluids, therefore, is scarcely an 
object of the present exercise. But an excess in 
the quantity of them, or as it is usually called 
plethora, being of more frequent occurrence, 
requires a more particular attention. 



$00 PATHOLOGY OP THE 



Plethora. 

When the general mass of circulating fluids 
is accumulated beyond that degree which is con- 
ducive to the perfection of health, there arises 
what the schools have denominated a plethora, or 
morbid fulness of the blood-vessels. There 
are few states of the system, perhaps, more 
troublesome than this over fulness of the vessels, 
especially when it has become habitual, or is of 
long standing, and begins to produce languor 
and oppression. It renders the body perpetually 
obnoxious to the most grievous, and even the 
most fatal disorders.* Every medical person 
must have heard of the famous declaration of 



* Nihil est, si forsan venena et animi affectus exceperis, quod 
tantam ruinam ac perniciem corpori minetur, atque illud tarn 
gravibus morbis obnoxium reddat, quam nimia succoram abun- 
dantia ; quia vires premit et motibus impulsoriis resistit, unde 
tardior fit sanguinis progressus, segniores etiam excretiones, a 
quibus tamen salvia prscipuse sanitatis functiones dependent. 
Hoffman, Medicin, Rational. System, torn. ii. p. 434. 



HUMAN FLUIDS. 201 

Hippocrates,* with regard to the athletic, or the 
full habited; and, in imitation of whom, Celsus 
elegantly observes, si plenior aliquis, et specio- 
sior, et coloratior faetus est, suspecta habere 
bona sua debet. Quae quia neque in eodem 
babitu subsistere, neque ultra progredi possunt, 
fere retro, quasi ruina quadam, revolvuntur.f 

By a plethora physicians understand an ex- 
cess or exuberance of good blood only; that 
is, where all the component parts of this fluid 
are equally increased in quantity. The conse- 
quences of an excess of either of the component 
parts of the blood, may be easily understood 
from preceding observations under the head of 
morbid fluidity. We have now to speak only 
of the excess of the whole mass. 



^a.TM> saxr/K. cv yoLg Suittvriti (Ann «» t» *WTta>, hvit AT^s/uittv. tTrt) cfe 
clx. <tr£ifAfot<riv, cln 'in S'vvcttTtti 'vxi to jUktioi imfiS'ov&f Ai/trsTa; ouv 
Wi to x-'i or - fovriaiv ouv uvfx.tr t»v tutginv h»ui ^vpftgu pn /ggetfTgw. 
Hippocrates, lib. i. Jlphor. 9. 
f Cexsus, lib. ii. cap. 3, 

2G 



202 PATHOLOGY OF THE 

Pathologists have enumerated different spe- 
cies of plethora,* which it may not be impro- 
per briefly to explain. The ancients, as we 
learn from Galen,! Paulus,J Avicenna,$ and 
others, divided it into two kinds: of these, one 
relates to the vessels, and was denominated a 
plethora ad vasa, and sometimes, ad molem, or ad 
venas ; the other has a reference to the strength 



* See Hoffman, Medicin. Rational. System, torn. ii. ; Gau- 
bips, Patholog ; Ludwig, De Plethorx Differentiis ; Gregory. 
Conspectus Medicinx ; &c. 

•J- Duas in universum notiones, relationesve plenitudinis 

proponamus : unam quidem, secundum robur viresque illius qui 
talem plenitudinem defert : alteram secundum excipientis vasis 
capacitatem. Galen, De Plenitudine. 

$ Copia vero ipsius sanguinis duplici modo capi demonstrate 
est: uno ad vires, vena licet plenx non appareant; in quo statu 
homo protinus infirmatur, et viribus destituitur, natura seu ad 
grave aliquod onus ferendum impotente. Altero ad vasa, qua 
id continent, in alia pondus loca transfundere spectantur : et si' 
virtus haud cum molestia ipsum toleret. Pawlus, lib. vi», 
cap. 40. 

^ Repletio secundum duos existit modos. Est etenim repleti© 
secundum vasa, et est repletio secundum virtutem, &c. Avi- 
CENKA, Opera, lib. i. fen. ii. doct. S. cap. 6. 



HUMAN FLUIDS. 203 

or natural powers, and was called a plethora ad 
"vires. The former is always and properly a true 
or absolute fulness ; but the latter is so relatively 
with respect to the natural powers only. Phy- 
sicians have mentioned two other kinds of ple- 
thora, viz. a plethora ad spatium, and a plethora 
ad volumen. 

By the plethora ad vasa, we are to understand 
a real exuberance of the absolute quantity of 
blood, or such a morbid accumulation of it 
within the vessels, as incommodes their actions 
by too much weight and distention. It occurs 
most generally in persons of strong, robust con- 
stitutions, who have vigorous digestive powers, 
are full feeders, and take but little exercise. In 
more lax habits, it is seen by the redness and tur- 
gescence of the minute vessels ; but the larger 
vessels, on the contrary, are more distended in 
firmer habits. 

The plethora ad vires supposes a greater quan- 
tity of blood than the strength will bear, with- 
out being overpowered and oppressed with the 
load. The vessels are not necessarily too full 
in themselves, but yet contain more than the 



20i pathology of the 

weakness of the moving powers is able to 
propel. This kind of plethora, therefore, must 
be relative to the constitution of the patient. 
An excessive plenitude, if not timely relieved* 
always becomes more or less of a burden, even 
to the most robust. We may also frequently 
have occasion to observe, that a small redundance 
of fluids, endured with impunity by the strong, 
will become oppressive, and sometimes even in- 
tolerable, to the weak. The plethora ad vires, 
therefore, has a just foundation, and may even 
exist under various forms. We may add, too, 
that it is probably a more frequent source of dis- 
ease than is generally suspected, and particu- 
larly difficult to relieve, inasmuch as it is mostly 
peculiar to lax habits of body, in whom the 
slightest diminution of the circulating fluids is 
not unfrequently productive of faintness, from 
the w T ant of a due contractile power in the ves- 
sels. 

The plethora ad spatium arises from the con- 
striction or diminution of the capacities of the 
vessels, the quantity and the bulk of the circu- 
lating fluids remaining the same. Consequently, 



HUMAN FLUIDS. 205 

it is a plelhora relatively to space only, and owes 
its origin altogether to a constriction or imper- 
vious state of some of the vessels ; as happens 
from cold weather, or from the accession of the 
cold fits of fevers, when in weak habits hemor- 
rhages have sometimes been the consequence. 
It also arises in advanced life from an oblitera- 
tion or impervious state of many of the smaller 
vessels. 

The plethora ad volumen, which is also called 
apparent or spurious, arises from an expansion 
or augmentation of the volume of circulating 
fluids, their quantity remaining unaltered. It 
happens from a great or sudden diminution of 
the pressure of the atmosphere, but more com- 
monly from great heat, either external or inter- 
nal, and the consequence of ardent and inflam- 
matory fevers, severe exercise, violent passions, 
spirituous liquors, friction, &c 

It is obvious that these different species of 
plethora are not inconsistent with each other; 
but they may all of them be occasionally com- 
bined in the same individual ; and the disease 
arising from such a union will of consequence 



206 PATHOLOGY OP THE 

be more dangerous, and sometimes; productive 
of sudden death. In the common acceptation 
of the term, however, plethora implies a fulness 
as to the vessels ; and in this sense it is chiefly 
used in the following pages. 

The quantity of the whole mass of blood 
cannot easily be reduced to measure ; nor, in- 
deed, is the proportion as to quantity or bulk so 
exactly limited, that every excess induces dis- 
ease. The latitude of health, which compre- 
hends age, sex, temperament, manner of 
living, &c. admits of some considerable variety 
in this respect. A small redundance easily en- 
dured by some may become a burden to others. 
But whenever the general mass of fluids is ac- 
cumulated to such a degree, as by the super- 
abundant load to have a tendency to overcome 
the power of the vessels, and to produce general 
languor and oppression, it then becomes morbid ; 
and if not timely relieved may prove the source 
of various and even fatal diseases. Such an 
overfulness of the vessels is generated by all 
those causes, which produce a large quantity of 
laudable chyle and blood, and at the same time 



HUMAN FLUIDS, 207 

prevent their attenuation and waste * To this 
end contribute a vigorous and healthy state of 
the digestive powers, together with a more lax 
and distensile contexture of the blood-vessels ; 
a liberal indulgence in a rich luxurious diet, and 
particularly the free use of animal food, with 
wine and other fermented liquors ; tranquillity 
of mind ; an indolent and sedentary manner of 
life, and much sleep, especially in those who 
have before been accustomed to active bodily ex- 
ercise; a suppression of habitual discharges, whe- 
ther natural or artificial ; but above all others, 
an obstruction or gradual diminution of perspi- 
ration ; and lastly, the habit of frequent blood- 
letting, provided the body be not entirely de- 
bilitated thereby, has also a tendency to create 
a plethoric state of the system, both by weaken- 
ing the action of the arteries, and of consequence 
diminishing in proportion the excretions; and 
by relaxing the vessels themselves, so as to dig* 



* Plethoram generat omnis causa, quae multum laudabilis 
dhyli, et sanguinis conficit, simulque horum attenuationem, con- 
sumptionem, perspirationeno, impedit. Boerhaaye, Aphon 
106, 



208 PATHOLOGY OF THE 

pose them to fill more easily. It is owing to 
these circumstances, that losses of blood, whether 
artificial or spontaneous, if within certain bounds, 
are commonly so soon recovered ; and where 
these losses are frequent they contribute to pro- 
duce or increase the plethoric state of the sys- 
tem, by creating a disposition to generate much 
blood, as well as by rendering the resistance of 
the vessels more weak, so as easily to yield to a 
preternatural accumulation of fluids. Women, 
by a natural constitution, monthly evacuate 
their superfluous blood; and just in the same 
term their vessels recover their former fulness 
and tension. They are in a special manner in- 
clined to a plethoric state of the system, after 
the natural cessation of the menses; and such 
preternatural fulness of their blood-vessels, if 
not relieved by occasional bleedings, in imita- 
tion of their former eFacuations, not unfrequent- 
ly lays the foundation of the most obstinate and 
fatal diseases. Men used to frequent evacua- 
tions of blood are, in like manner, obliged to 
have their vessels regularly emptied at their 
accustomed periods of bleeding, otherwise they 



HUMAN FLUIDS* 209 

suffer the same inconveniences as women do by 
the suppression or retention of their menses. 
Wiuter and spring are also favourable to the 
-rise of plethora ; and cold and temperate 
regions, rather than places that are hot and 
dry. 

A morbid fulness of the blood-vessels, there- 
fore, is more especially the complaint of the 
sedentary, inactive, and relaxed, who indulge 
too liberally in generous diet and drinks. It 
occurs chiefly in the luxurious female, whose 
pampered appetite is the means of preparing a 
superabundance of chyle and blood, whose lax 
and distensile vessels easily yield to an incum- 
bent load of fluids, and whose secretions, from 
habits of idleness and inactivity, are slow and 
inconsiderable. Men of laxer habits, whose 
vessels in weak resistance approach the female, 
in similar situations, are equally prone to a pre- 
ternatural fulness of the vascular system. 

A plethora of the blood-vessels is said to be 
the complaint chiefly of youth and middle age; 
but it is also a frequent occurrence in more ad- 
vanced life, that is, after the period of forty-five 

27 



210 PATHOLOGY OF THE 

or fifty ; for, as it has been judiciously observed, 
" although the system may be debilitated by 
age, it should be recollected that the secretions 
are also impaired from diminished exercise at 
that period of life, and that an accumulation 
takes place in the larger vessels, especially in the 
venous system."* It is certain that many women, 
after the natural cessation of the menses, (which 
in our climate generally takes place at about 
forty-five,) are more inclined to a general ple- 
thora of the sanguiferous system, than at any 
previous period of life ; and such fulness, if not 
occasionally relieved by the use of blood-let- 
ting, in imitation of their former monthly eva- 
cuations, not unfrequently lays the foundation 
of the most dangerous and incurable diseases. 
Some females, at that time of life, frequently re- 
quire as large, or perhaps more copious extrac- 
tions of blood, than at the earlier periods of life ; 
and this principle of practice holds equally 
good with regard to robust men with large ves- 



* Ho sack, Quarterly Report of the Diseases of New- York. 
in the Amer. Med. and Philos. Register, vol. i. 



HUMAN FLUIDS. 211 

sels, and to persons who are accustomed to free 
and generous living, or who labour under a sup- 
pression of some habitual discharge. 

It is a common, though palpable error, to 
affirm, that evacuations by the lancet are abso- 
lutely improper in advanced life ; as if persons at 
this period were so far from being subject to 
repletion of the blood-vessels, that they were 
rather afflicted by inanition. It is true, indeed, 
that all persons, in advanced life, are not neces- 
sarily plethoric, and consequently do not require 
depletion by the lancet ; nor does age of itself, 
independent of all other circumstances, contri- 
bute to an over fulness of the sanguiferous sys- 
tem. But at the same time, it must be recollect- 
ed, that there are some sound, vigorous, and ro- 
bust old persons, who are possessed of capacious 
vessels, and not only liberally indulge in the free 
use of nutritious aliments, but also have strong 
digestive and assimilating powers, capable of 
converting the most solid food into laudable 
chyle and blood ; in consequence of which it is 
not to be doubted that accumulations will take 
place in the vascular system, which, indeed, is 



212 PATHOLOGY OF THE 

sufficiently obvious from the florid colour of 
the countenance, and the tumescence of the ves- 
sels themselves. But, moreover, the body in ad- 
vanced life is less fitted for motion or active ex- 
ercise; whence the excretions must be more 
slow and inconsiderable, and cannot bear a due 
proportion to the ingesta. And as little blood is 
consumed by heat, motion, and nutrition, there 
must necessarily be produced a superabundance 
of fluids, and a plenitude or overloaded state of 
the vessels ; which, unless seasonably and occa- 
sionally removed by the use of the lancet, or 
some salutary effort of nature itself, will fre- 
quently lay the foundation for many of the 
complaints incident to advanced life; such as 
giddiness, apoplexy, palsy, numbness of the ex- 
tremities, gout, hemorrhoids, dropsical effusions, 
coughs, difficulty of breathing, hydrothorax, 
angina pectoris, visceral obstructions, itchings 
or erysipelatous eruptions, calcareous concre- 
tions, affections of the urinary organs, pains 
in the joints, &c. which often arise from or 
are connected with a plethoric state of the sys-c 
tern. 



HUMAN FLUIDS. 213 

The timid and preposterous conduct of those 
physicians who object altogether to evacuations 
by the lancet in the diseases of advanced life, 
cannot be too severely reprobated. The same 
may be said concerning the neglect of this reme- 
dy in those premonitory symptoms of apoplexy 
and palsy which proceed from an overloaded 
state of the blood-vessels. We are by no means, 
however, to conclude, that blood-letting would 
be proper in all persons in advanced life. On 
the contrary, in such as are not affected with 
any fulness of the vessels, but are weak and 
languid, who have lost their appetite and di- 
gestive powers, or labour under a weakness of 
the stomach and intestines, and especially in 
those who have long been afflicted with some 
chronical disorder, this evacuation would be 
manifestly injurious, if not productive of the most 
serious consequences. 

But where there is a plethora, or fulness of 
the sanguiferous vessels, age alone can certainly 
afford no objection to the use of the lancet. 
Our celebrated countryman, Dr. Rush, to whose 
learning and talents the medical literature of this 



214 PATHOLOGY OP THE 

country is so much indebted, in a particular 
manner, recommends bleeding in the acute dis- 
eases of advanced life, which are attended with 
plethora, and an inflammatory action of the 
pulse. He further observes, that he has even 
seen many of the chronic complaints of old 
people mitigated by it. " The degrees of appe- 
tite," says he, " which belong to old age, the 
quality of the food taken, and the sedentary life 
which is generally connected with it, all concur 
to produce that state of the system, which re- 
quires the above evacuation."* The observa- 
tion and experience of Dr. Hosack, during a 
long and extensive practice, are in corrobora- 
tion of the preceding opinions; and the same 
mode of treatment has accordingly been re- 
commended by him, with an earnestness arising 
from a conviction of its importance. In his 
quarterly reports on the diseases of the city 
of New-York, among other observations of the 
same import, are the following : " We have 
before remarked, that the use of the lancet is 



* Rusg, Medical Inquiries and Observations, vol. r. 



HUMAN FLUIDS. 215 

especially indicated in the plethora of advanced 
life, when the excretions are necessarily diminish- 
ed from the diminished action of the excretory 
vessels. We cannot withhold the expression of 
our surprise, that this opinion should be resisted 
by the practitioners of our city, as we observe it 
has been in a variety of instances ; and by men 
too, whose education and whose opportunities of 
observation should have given them different 
views of this subject, and have led them to dif- 
ferent practice."* 

Many instances might be produced to show 
that evacuations by the lancet are not only use- 
ful to persons in advanced life, but, also, power- 
fully contribute to prolong life, and to preserve 
the body free from many of the complaints in- 
cident to old age. We are informed by Wep- 
FER,f that almost all the Swiss, even when eighty 
or ninety years of age, use blood-letting every 
year, as a means of warding off diseases. 



* Vide Amer. Med. and Philos. Register, vol. ill 
$ Wepfer, De Apoplexia, 



216 PATHOLOGY OF THE 

Would our limits permit, we might here ad- 
duce many facts to prove, that age may commo- 
diously bear evacuations of blood. Dr. Hosack 
mentions the case of a female patient, in the 
eighty-fifth year of her age, who, " in the course 
of three days, lost by hemorrhage from the lungs, 
at the least calculation, two quarts of blood. 
Very nearly as much more, in the same period 
of time, was taken from her arm, when the he- 
morrhage ceased." He further adds, that " she 
has since recovered, without any injury to her 
constitution, from the loss of blood she has sus- 
tained."* It is well known, that persons ex- 
tremely old not unfrequently discharge large 
quantities of blood from the hemorrhoidal veins, 
without any remarkable loss of strength. Drs. 
Hosack and Francis have recently had undei 
their care a lady of this city, upwards of seventy 
years of age, who formerly laboured under a 
hemorrhoidal discharge, but has for the last two 
years been subject to violent and frequent at- 



* Vide Quarterly Report of the Diseases of the City of New- 
York, in the Amer. Med. and Philos. Register, toI. iii. 



HUMAN FLUIDS. 217 

tacks of apoplexy, removable only by the libe- 
ral use of the lancet, which has been employed 
no less than thirty times within the space of 
twelve months, and with uniform success. The 
patient at present enjoys much better health 
than for many years before. But the writer 
forbears to enlarge under this head. He might 
record the particulars of many other cases of a 
similar nature which have occurred in the prac- 
tice of his preceptor, and which have fallen 
under his own immediate observation. 

The existence of a plethora or redundance of 
blood is easily ascertained by the habits of life, 
together with certain appearances and feelings 
of the patient. The principal symptoms by 
which it is characterized are, inordinate redness 
of the whole body, and more especially of the 
face; repletion and distension of the vessels; 
and a particular kind of pulsation in the arteries, 
which always feel full, or of considerable size, 
hardly receding from the finger, so that a very 
small difference is perceptible between their con- 
traction and relaxation. The pulse, however, 
does not always convey a perfect idea of 

28 



,218 PATHOLOGY OF THE 

this state of the system, and without caution 
might often mislead an inaccurate observer. 
Sometimes it is strong and hard, but more fre- 
quently is obscure or oppressed, and often ap- 
parently weak and low ; but when firmly pressed 
the artery does not easily give way, nor is the 
current of blood checked. If, observes Mr. 
Bromfield,* three or four fingers cover a con- 
siderable length of artery, and we press hard 
for a time on it, and then suddenly raise all the 
fingers, but that nearest the patient's hand, the 
influx of blood, if there be a plethora, will be so 
rapid, as to raise the other finger, and make us 
sensible of the fulness. 

This particular feel of the pulsation of the 
arteries in plethora has been called oppression of 
the pulse, and may be easily understood by con- 
sidering plenitude in the extreme ; for it is ob- 
vious that an artery surcharged with blood is as 
incapable of producing a strong, free, and bound- 
ing pulse, from its inability to contract freely 



* Bromfield, Chirurgical Observations and Cases., vol i» 
n. 58, 



HUMAN FLUIDS, 2l£ 

tfpon, and get rid of, the superabundant load of 
fluids, as from want of a due quantity for its dis- 
tension. To an inattentive observer the pulse 
will, in both cases, appear low and weak. From 
this circumstance arises the curious phenomena 
of the circulation becoming more accelerated, 
and the pulse stronger, after bleeding a pletho- 
ric person. By diminishing the superabundant 
quantity of fluids, it restores the over distended 
vessels to their former contractions and elasticity, 
and thus necessarily increases the momentum of 
the circulation. It is on this principle that mo- 
derate evacuations of blood often remove ob- 
structions and promote suppressed excretions, 
not only of blood, but also of urine and perspi- 
ration.* The extraction of a few ounces of 
blood from a plethoric female often almost in- 
stantaneously restores the menstrual discharge. 
HoFFMANf remarks, that he has frequently ob- 
served the hemorrhoidal discharge, after having 
been long stopped, restored by venesection. 



* Boerhaave, Institut. Med. ^ 1228. 

t Hoffman, Medicin. Rational. System, torn, iii.p. 55S. 



220 PATHOLOGY OP THE 

Hippocrates* informs us, that blood-letting re- 
moves a difficulty or suppression of urine. Ri- 
VEKiusf also affirms, that after venesection the 
urine has not only been evacuated more co- 
piously, but also of a deeper colour. It is fre- 
quently of great importance to take away a due 
and proper quantity of blood, from persons 
whose vessels are overcharged. Hoffman J ob- 
serves, that he has known many instances, where 
in an extreme degree of plethora the extraction 
of a small quantity of blood only, as for in- 
stance two or three ounces, has a few hours after 
been succeeded by an apoplectic fit, which has 
been happily removed by a liberal venesection 
in the arm. But it may here on the other hand 
be remarked, that the very copious and repeated 
evacuations by the lancet prescribed by some 
practitioners, in cases of apoplexy and palsy, 
are necessarily injurious, even in the most ath- _. 
letic, and " not to be justified either by reason- 



* Hippocrates, lib. vi. Aphor. S6. 

f RivERius,Cent. prim. Observ. 1. 48. 8tc. 

| Hoffman, Medicin. Rational. System, torn. iii. p. 569. 



HUMAN FLUIDS. 221 

ing or practice." Such large and sudden eva- 
cuations of blood, by prostrating the powers of 
life, leave the already torpid and paralized ves- 
sels in a state of collapse and inaction, from 
which they frequently never recover. 

Beside the symptoms or appearances already 
enumerated, the existence of a preternatural 
fulness of the blood-vessels is further pointed 
out by its effects upon the body ; and particu- 
larly by pains in the head, back, and loins, fre- 
quent vertigo or giddiness, numbness of the ex- 
tremities, a somewhat anxious or oppressive 
breathing which is at times attended with a pe- 
culiar sense of straitness of the trachea, general 
lassitude and oppression, especially after an in- 
crease of motion or heat in the weather, disin- 
clination to exercise, whether of body or mind, 
dulness with frequent drowsiness, or a strong 
propensity to sleep. 

Such are the symptoms which supply us with 
a perfect diagnostic of plethora, which, in a more 
extreme or inordinate degree, often produces 
transitory disturbances of some or all the senses, 
and even impairs the intellectual faculties, and 



222 PATHOLOGY OF THK 

more especially the memory. For the mind, to 
perform its functions with acuteness and preci- 
sion, requires a free, delicate, and moveable state 
of the brain and nerves, which renders them 
more susceptible of impressions, or the motions 
subservient to thought. But such mobility and 
sensibility of the brain and nerves is necessarily 
impaired by the compression occasioned by an 
overdistension of the blood-vessels. 

It may be here remarked, that the veins in the 
beginning of life, as appears from the experi- 
ments of Sir Clifton Wintringham,* are con- 
siderably more dense and strong than the arte- 
ries. But the latter, on account of the con- 
tinual pressure and distension which they neces- 
sarily suffer from the action of the heart, are 
daily increasing in density and strength, till at 
length ttTey not only equal, but even surpass the 
force of the veins, which from not being subject 
to the same power of the heart are little, if at all, 
increased in this respect, but remain nearly the 



* Experimental Inquiry on some parts of the Animal Strur 
tare. 



HUMAN FLUIDS. 223 

tfame throughout life. It is owing to this circum- 
stance that the proportional quantities of blood 
in the arteries and veins must change in the 
course of life, and that if a general and preter- 
natural plethoric state occur in early life, it must 
especially appear in the arterial system ; but at an 
advanced period such plethora will show itself 
chiefly in the venous system. For the density of 
the arteries with respect to that of the veins 
being greater in early than in advanced life, it 
must necessarily happen that the resistance to the 
passage of the blood from the arteries into the 
veins, is greater in young than in old persons ; 
and so long as this resistance continues, the ar- 
terial system will be the most inclined to a pre- 
ternatural fulness. But since the density of 
the arteries is constantly increasing, whilst that 
of the veins remains nearly the same, it is ob- 
vious that the resistance of the former will, in 
time, not only balance, but prevail over that of 
the latter ; and whenever this takes place, (which, 
in the human body, is generally supposed to be 
about the age of thirty-five,) a proportionably 
greater quantity of blood will be thrown into 



224 PATHOLOGY OF THE 

the veins, and by this means the fulness of the 
arteries will be in some measure taken off, so 
that the occurrence of a general plethora of the 
system, after this period, must especially manifest 
itself in the veins. Hence appears the reason 
of the different diseases incident to certain 
periods of life, as also why many disorders of 
the young gradually wear off, and sometimes 
entirely disappear without any assistance from 
art, as the body approaches to its greatest 
strength and maturity. Nor is it less apparent 
why many of those affections which are incident 
to age should gradually increase notwithstand- 
ing the interposition of the greatest skill to 
prevent it. 

The females of most or perhaps of all animals 
have their arteries more capacious and lax, com- 
pared with the veins, and the veins themselves 
much smaller than the. males of the same 
species.* Owing to these circumstances women, 
ceteris paribus, are more disposed to a plenitude 
than men. 



* Ghebory, Conspectus Medicinse. 



HUMAN FLUIDS. 22& 



Diseases of Plethora. 

Many are the evils which arise from an over 
fulness and distention of the blood-vessels. It 
sometimes produces oppression of the strength, 
with irritability and languor.* But more fre- 
quently, perhaps, the distended vessels are ren- 
dered prone to vehement or inordinate mo- 
tions. The equilibrium between the solids 
and fluids being destroyed by an over propor- 
tion of the latter, the freedom and equability 
of the circulation are necessarily impaired. 
Whilst the blood, by its too great quantity, 
strongly resists the contractile and elastic force 
of the heart, arteries, and other vessels, its 
progressive motion through the whole body is 



* Multa mala a nimia plenitudine oriuntur. Homo nonnun- 
quam fere opprimitur, hebes, languidus, debilis fit, neque ipsa 
qux sanguinem movent organa ad tantum onus impellendum 
valent. Pulsus languet, et aliquando syncope, et vertigo, et pal- 
pitatio observantur. Ssepius vero vasa nimis distenta, ad motus 
praeter solitum vehementes et abnormes proclivia fkmt. Gre- 
gory, Consmdus Medicinae, ^ 509. 

29 



226 PATHOLOGY OF THE 

not only retarded, so that it becomes more 
apt to degenerate into impurities, and form 
obstructions of various kinds, but, further, in 
irritable habits, and in highly nervous parts, by 
exciting spasmodic strictures, or violent and 
inordinate action, it induces inequalities in the 
distribution of blood, and occasions preternatu- 
ral congestions or accumulations of the same in 
particular parts of the sanguiferous system. 

A consideration of these circumstances will 
lead to a knowledge of the various affections, 
both acute and chronic, that either proceed from, 
or are aggravated by, a plethora. It predisposes to 
febrile and inflammatory diseases, apoplexy, and 
palsy ; to preternatural congestions ; to obstruc- 
tions, and indurations of glandular organs ; to ex- 
travasations, hydropical effusions, rupture of the 
blood-vessels, and hemorrhage. Moreover, on 
account of the pain and irritation produced by 
the distending blood, in the more nervous and 
membranous parts of the body, excessive mobi- 
lity, and a disposition to spasmodic affections, 
and other diseases of the same kind, not unfre- 
quently arise from plenitude. Hippocrates has 



HUMAN FLUIDS. 227 

very justly observed that spasms proceed from 
immoderate repletion, as well as from depletion, 
or too small a quantity of the animal fluids: 

£7ra.<rp.ci yhovritt » vtto •7r).iigoc<rio( ) ri Ktvurios.* Repletion of 

the vessels, however, is not equally productive 
of spasm, or convulsive action in every person, 
nor in every part of the body. This action 
occurs most frequently in irritable habits, 
and takes place in those parts only which are 
highly membranous, or are liberally supplied 
with nerves; so, according to the difference of 
these, there is produced a greater or less ten- 
dency to spasmodic and other similar disorders/}" 
Nervous irritations and spasmodic or convulsive 
affections of different kinds are doubtless fre- 
quently to be attributed to, or are kept up by, 



* Hippocrates, Aphor. 39. lib. vi. 

f Ubicunque sanguis intra membranas nerveas et carneas. 
subsistit, stagnat, easque valde distendit, ibi dolor et spasmus 
gignitur, qui tanto vehementior est aliasque nerveas simul partes 
In consensum abripit liberumque et sequabilem sanguinis circui- 
turn pra?pedit, quanto stagnatio et repletio vasorum major est 
et quo exquisitioris membrane sensationis sunt ac validiorerii 
potentiam motricem habent. Hoffman. Median. Rational. 
System, torn. ii. p. 450. 



228 I'ATIIOLOGY OF THE 

plethora and distention of the blood-vessels. 
Dr. Darwin remarks, that venesection will often 
instantaneously relieve those nervous pains 
which attend the cold periods of hysteric, asth- 
matic, or epileptic diseases ; and that even when 
large doses of opium have been in vain exhibit- 
ed. In these cases, says he, the pulse becomes 
stronger after the bleeding, and the extremities 
regain their natural warmth; and opium then 
given acts with much more certain effects.* 
We are informed by Dr. Cullen, that hysteria 
more especially affects females of the most 
sanguine and plethoric habits, and frequently 
those, too, of the most robust and masculine con- 
stitutions/]- Females who menstruate too spar- 
ingly, or who labour under an entire suppres- 
sion of this evacuation, by which the vessels 
of the uterine system and other sensible parts of 
the body become over distended with blood, are 
not only affected with violent pains in the head, 
back, loins, and other parts of the body, but are 



* Darwi>", Zoonomia, vol. ii. p. 41. 
t Cullen, First Lines, 5^ 1517. 



HUMAN FLUIDS. 229 

iri like manner subject to spasms, convulsions, 
and other affections common to hysteric persons. 
Suppression of urine and of the catamenia may 
also proceed from too great fulness of the ves- 
sels of the kidneys, and of the uterus ; and conse- 
quently in such cases they may be frequently 
and most effectually restored by blood-letting. 

The effects of a redundance of blood are par- 
ticularly observable in the head, in which the 
circulation is naturally very slow, and the ves- 
sels themselves of a delicate structure; both of 
which circumstances are peculiarly favourable 
to the formation of preternatural congestions. 
Hence it is, that plethoric persons are so fre- 
quently carried off by apoplexy, a vessel being 
ruptured in the brain. It is to be presumed, 
however, that an actual rupture of the vessels, or 
an effusion either of blood or serum, are not al- 
ways necessary to the production of this disease ; 
but that it may, and indeed does sometimes pro- 
ceed merely from too great fulness of the large 
vessels of the brain. For the head being natu- 
rally entirely full, and the hard bone of the cra- 
nium incapable of yielding, it follows that if the 



230 PATHOLOGY OF THE 

larger vessels which carry red blood be distend- 
ed beyond their natural bulk, the smaller ones 
will necessarily be compressed, and the functions 
of the head thereby disordered. And thus, as 
Van Swieten* has justly remarked, may all the 
diseases of the brain, from a slight vertigo to a 
mortal apoplexy, take their rise from a ple- 
thora. 

The heart and lungs are also among the parts 
that are often affected by an exuberance of 
fluids. The blood being too great in quantity is 
with difficulty thrown into the vessels. Whence 
the circulation becomes laborious, the heart 
itself is oppressed, and sometimes palpitation 
and syncope ensue. From the resistance, too, 
that is made to the blood, which is driven from 
the left ventricle of the heart, the pulmonary 
veins will be less able to empty themselves into 
that organ, and, therefore, accumulations will 
necessarily take place in the lungs. Owing to 
this turgescence of the blood in the pulmonary 
vessels, plethoric persons are not unfrequently 



* Van Swiexew, Commentar. ^ 106 



HUMAN FLUIDS. 231 

the subjects of hemoptysis; and for the same 
reason they are often liable to habitual catarrhal 
affections, to hoarseness, to difficulty of breath- 
ing, and effusion of water in the chest. 

But if a plethoric state of the general system, 
and particularly of the venous vessels, take place, 
it is to be presumed that it will especially affect 
the abdominal viscera, or those parts connected 
with the system of the vena porlarum. The 
great number, size, and dependent situation of 
those veins which form the vena portarum, and 
the want of valves in them to support the per- 
pendicular columns of blood, all contribute to 
retard the circulation, and to render the motion 
of the venous blood more slow here than else- 
where. The evils, as Dr. Hoffman remarks, 
which proceed from this retarded motion and 
consequent accumulation of blood in the vessels 
of the abdomen, arise sometimes from irritation 
and spasmodic stricture of the membranous 
and nervous parts, excited by the distending 
blood, and sometimes from a l<8ss of tone in the 
viscera, or from obstructions and indurations. 
Many of the diseases of the bowels and other 



232 PATHOLOGY OF THE 

abdominal viscera may therefore proceed fro in 
a turgeseence of the blood in the vessels of these 
organs.* Sometimes the distended vessels unload 
themselves by excessive hemorrhages from the 
liver, stomach, and intestines. But as no part 
of the abdomen is more largely supplied with 
blood than the liver, so there is none more liable 
to diseases proceeding from this cause. 

Among the disorders arising from a general ple- 
thora of the system, we have enumerated drop- 
sies, or those morbid accumulations of watery 
or serous fluids that sometimes take place in 
different parts of the body. That dropsy de- 
pends frequently, or, perhaps, in a majority 
of cases, upon this cause is amply confirmed 
by the experience of many who have enjoyed 
extensive opportunities of observation in this 
disease. Experience, says Dr. Hosack, has 
long since taught me that dropsy arises as often, 
nay, more frequently, from increased exha- 



I 

* Vide Dewar, Observations on Diarrhoea and Dysentery : 
Hosack, Quarterly Report of the Diseases of New-York, in 
the Amer. Med. and Philos. Register, vol. ii. 



HUMAN FLUIDS. 233 

lation, the effects of an overloaded state of the 
blood-vessels, than from diminished absorption, 
occasioned from a loss of tone in the absorbent 
vessels ; and consequently this affection may, and 
no doubt frequently does, proceed from the want 
of blood-letting as well as from the excessive 
use of that evacuation. I have seldom, if ever, 
says he, attended a case of dropsy of the chest that 
did notarise from increased exhalation, and, in 
almost every instance, the complaint has been re- 
moved by blood-letting and other evacuants. The 
same may be said of the hydrocephalus of adults, 
which is always, I consider, preceded by, or ac- 
companied with, inflammation.* 

In confirmation of the correctness of these 
opinions, the writer could, in this place, record 
many instances of hydrothorax, ascites, and 
anasarca produced by such fulness of the san- 
guiferous system, and which were relieved by 
venesection, and other depleting remedies. The 
following cases, however, which occurred in the 
practice of his preceptor, must suffice : 

* MS. Notes on Hosack's Lectures. 
30 



234 PATHOLOGY OF THE 

"A gentleman of this city, a Mr. C l, 

about sixty years old, was unable to lie down for 
nearly three months, owing to an accumulation of 
water in the chest, attended with cough, labo- 
rious respiration, and diminished secretion of 
urine, accompanied, at the same time, with a 
degree of anasarcous swelling of the lower ex- 
tremities. Eut by means of repeated bleeding, 
and the combination of calomel and squills, the 
symptoms above mentioned have totally disap- 
peared ; and, by the subsequent use of tonics, 
he has so far recovered his strength as to return 
to his usual active occupation. In another case, 
the patient, in his seventy. seventh year, of a 
plethoric habit of body, has, within the last six 
weeks, been attacked both with ascites and ana- 
sarca combined, attended with all the character- 
istic symptoms of those diseases. As these were 
induced from the want of exercise, the patient 
at the same time taking his customary food and 
stimulant drinks, the depleting treatment was 
deemed expedient. Fourteen ounces of blood 
were accordingly taken from his arm, followed 
with repeated doses of rhubarb, and the sulphate 



HUMAN FLUIDS. 235 

of potash. During the use of these remedies, 
his usual drinks, which consisted of spirits, or 
brandy and water, as well as the use of animal 
food, were continued, but in less quantity than 
ordinary. The tumour of the belly, and swell- 
ing of the extremities, were sensibly diminished 
by the evacuations procured, and by the subse- 
quent use of chalybeates and other tonics, his 
health is perfectly re-established."* The case 
of the late Dr. Dancer, who was for many 
years a distinguished practitioner in the West- 
Indies, affords another example equally instruc- 
tive. Having for more than twelve months, in 
Jamaica, laboured under all the characteristic 
symytorns of hydrothorax, with evident ascites 
and general anasarca, he, in July, 1810, came 
to the city of New- York, and placed himself 
under the care of Dr. Hosack. As he was now 
somewhat advanced in life, had been a free and 
generous liver, and withal was naturally of a 
robust plethoric habit of body, there was little 



" :f Hosack, Quarterly Report of the Diseases of New- York, in 
the Amer. Med. and Philos. Register, vol. iii. 



236 PATHOLOGY OF THE 

difficulty in discovering the nature and source oi 
his complaint, and the treatment necessary to be 
pursued. Accordingly, after the operation of 
paracentesis, (by which eight quarts of fluid 
were drawn off,) and of liberal and repeated 
venesection, together with other depleting re- 
medies and corresponding treatment, the symp- 
toms of his disorder subsided, and in a short time 
his general health was so far recovered as to 
enable him to perform a tour of several hundred 
miles through the country. In the ensuing No- 
vember he departed for the West-Indies. 

Dropsy from general plethora appears to be a 
much more frequent occurrence in advanced 
than in early life. It is probably owing to this 
circumstance, that the fulness of the venous sys- 
tem, which seems to increase as life advances, is 
greater in late than in early life. But every ac- 
cumulation that takes place in the veins must ne- 
cessarily resist the free passage of the arterial 
blood into them, and consequently there will be a 
greater resistance at the extremities of the arte- 
lies. This again must be productive of preter- 
natural congestions in the extremities of the red 



HUMAN FLUIDS. 337 

arteries* and therefore of some increased action 
in them, which, superadded to the vis a tcrgo or 
impulsive action of the heart, must determine 
the fluids with more than usual force upon the 
extremities of the arteries and the exhalent ves- 
sels proceeding from them ; the special effect of 
which will be to produce an increased effusion 
from the exhalent vessels. In this manner, it is 
to be presumed that hydrothorax, ascites, and 
other forms of dropsy arise so frequently from 
plethora of the blood-vessels, particularly in ad- 
vanced life, and might frequently be prevented 
by the use of the lancet. 

This distinction between the different kinds 
of dropsies, when arising from diminished ab- 
sorption, the consequence of debility of the ab- 
sorbents, or from increased exhalation, the effect 
of plethora and excessive action, necessarily 
leads to the most important practical applica- 
tion.* As in the latter kind there is an urgent 



* From not adverting to this distinction between the different 
species of dropsy, and the treatment indicated in each, may 
doubtless be attributed the pernicious effects which have so fre- 



233 PATHOLOGY OF THE 

call for the use of the lancet, so in the for- 
mer, this treatment is to be as carefully avoid- 
ed. The writer is aware thai the opinions here 
expressed, as to the nature and character of dif- 
ferent sorts of dropsies, and especially the mode 
of treatment he has recommended, will, by the 
majority of physicians, be considered as heresies. 
But as it respects blood-letting, the use of which 
it is his object particularly to recommend in 
dropsies connected with a general plethora of 
the system, he may observe, that it has been pur- 



quently been ohserved to follow the indiscriminate use of the 
digitalis in this disease. The digitalis can be employed with 
advantage in those kinds of dropsies only which arise from a ge- 
neral plethora or fulness of the blood-vessels. " I have frequently 
witnessed the exhibition of digitalis, in substance and in tincture, 
in many cases of ascites and in general dropsy which have oc- 
curred in the New-York Hospital. The remedy, in a large majori- 
ty of cases, was exhibited in the secondary stageof the disorder, 
when symptoms of fulness or preternatural excitement did not 
exist. In no case of this nature was the use of the digitalis fol- 
lowed with salutary effects ; on the contrary, it added to the de- 
bility under which the patient already laboured, and, instead of 
mitigating, augmented the disorder." MS. Notes on Frakcis' 
Lectures on Materia Medica. 



HUMAN FLUIDS. 239 

sued with (he most decidedly beneficial effects 
in the practice of his preceptor. He may also 
remark, that the use of blood-letting in dropsy 
has long since been sanctioned by the authority 
of Leokardus Botallus, a celebrated physician 
of the sixteenth century, and more recently by 
our late distinguished countrymen, Dr. Rush, 
and also by Dr. Blackall of London, in his late 
valuable Treatise on Dropsies. 

Another disease which appears to depend 
chiefly upon an overloaded condition of the 
blood-vessels, is angina pectoris. For the first 
accurate and satisfactory account of the symp- 
toms of this disorder, the world is indebted to 
Dr. William Heberdek* of London. Cases 
of an affection, however, in many respects simi- 
lar, had been previously observed and recorded 
in the writings of Hoffman! and Morgagni.J 

With respect to the nature and causes of 
angina pectoris, physicians have entertained a 



* Medical Transactions, vol. ii. 
| Consultationes Medicas, vol. i, 
} De Sed. ct Cans. Morborum, 



240 PATHOLOGY OP THE 

great diversity of opinion. From the limited 
view which has generally been taken of this 
disorder, by merely regarding it as characterized 
by some remarkable symptom or appearance, to 
the exclusion of others equally important, and 
more especially its connexion with the whole 
system, physicians, in many instances, have ne- 
cessarily, though inadvertantly, been led into 
error. Dr. Heberden* supposed it to be owing 
to spasm,, or convulsion of the part affected. 
Dr. WALLf mentions a case in which he attri- 
buted the origin of the complaint to a rigidity 
or induration of the semi-lunar valves at the be- 
ginning of the aorta. A similar opinion is en- 
tertained by Dr. Matthew Baillie, relative to 
the ossification of the valves of the heart. Other 
morbid appearances, such as preternatural accu- 
mulations of fatj about the heart, and an en- 
largement of that organ or of the greater vessels, 
have been mentioned among the causes of angina 



* Medical Transactions, vol. ii. 
t Medical Transactions, vol. iii. 
% Macbride, Medical Observ. and Inquir. vol. vi. 



HUMAN FLUIDS. 24l 

pectoris. A gouty humour, spasm of the heart, 
anxiety, and excessive indulgence of the vehe- 
ment emotions of the mind, are likewise enume- 
rated as causes. Dr. Bergius, a Swedish phy- 
sician, considers this complaint as a kind of spas- 
modic asthma. Elmer and Schmidt, of Ger- 
many, also believe it to be a species of asthma : 
and of the same opinion was Dr. Darwin, who 
denominates it asthma dolirificum. 

Dr. Parry,* a distinguished writer, has lately 
endeavoured to show that angina pectoris arises 
from an ossification of the coronary arteries of 
the heart, an opinion which seems to have gained 
many able advocates, and among others may be 
mentioned Dr. John Augustine Smith, profes- 
sor of anatomy and surgery in the University of 
the State of New- York. Several objections 
might be urged against this theory of Dr. Parry. 

In the first place, angina pectoris generally oc- 
curs in advanced life, when such ossifications 
are not uncommon in different parts of the body* 



* Inquiry into the Symptoms and Causes of Syncope Angi- 
nosa. 

31 



242 PATHOLOGY OF THE 

Ossified coronaries, therefore, are rather to be 
considered as an accidental circumstance. 

Secondly, cases of ossified coronaries are re- 
corded of patients who did not labour under 
the symptoms essential to this disease.* 

Thirdly, but the great and indeed fatal objec- 
tion to the theory of Dr. Parry, and of all others 
founded upon ossifications or other derange- 
ments about the heart, is, that this organ and its 
appendages in several well authenticated cases 
of angina pectoris have, upon dissection, been 
found in their natural state. A case of this 
complaint is recorded in the Medical and Physi- 
cal Journal,! and another by Dr. Hosack, in the 
American Medical and Philosophical Register,:]; 
in both of which it is expressly stated that the 
coronary vessels were free from disease or any 
ossification. 

Dr. Hosack, who has met with several cases 
of angina pectoris in his practice, taking into 

* Vide Warren's Cases of Organic Diseases of the Heart ; 
and, also, Morgagni, De Sed. et Caus. Morb. 
f Vol. xvi. p. 487. 
+■ Vol. ii. p. 471, 



HUMAN FLUIDS. 243 

view the circumstances connected with this com- 
plaint, and particularly the time of life, the habit 
of body, and the season of the year in which it, 
for the most part, occurs, is induced to consider 
the disease as most generally proceeding from a 
plethora of the blood-vessels, more especially 
from a disproportionate accumulation in the 
heart and larger arteries* The deposites of fat 
observed upon dissection, as well as the effusions 
of water in the thorax and pericardium, the en- 
largement of the heart, the preternaturally dis- 
tended state of the vessels themselves, and even 
the bony deposites occasionally met with in the 
heart and its appendages, are all, he considers, 
favourable to this conclusion, these being for the 
most part the effects of plethora. f In further 
confirmation of the correctness of his opinions, 
it may be remarked, that it appears from the his- 
tories of this complaint, that the persons the 
most subject to it are those advanced in life, of 
sedentary and gouty habits, with short necks, 



* Amer. Med. and Philos. Register, vol. ii. 
} MS. Notes on Hosack's Lecture?, 



244 PATHOLOGY OP THE 

and who are full feeders, and inclined to be 
corpulent. Hemorrhages, or spontaneous dis- 
charges of blood from different parts of the 
body, anxious and oppressive breathing, numb- 
ness of the extremities, and giddiness, have often 
been observed in persons subject to this disease, 
and are all evidences of an overloaded state of 
the blood-vessels. The successful treatment, 
too, of angina pectoris by active cathartics, 
blood-letting, and other evacuants, calculated 
to diminish the fulness of the vessels, can leave 
no doubt of its relation to plethora. 

But the writer forbears to enlarge upon this 
subject. For a more ample view of this opinion 
with regard to the nature of angina pectoris, 
he refers the reader to an interesting Disserta- 
tion on this subject, published by his fellow 
graduate, Dr. Henry Bogart. 

The last disease which we shall mention, in 
connexion with the present subject, is gout. 
That this complaint is frequently aggravated by, 
and in many respects dependent upon, a plethora 
of the blood-vessels, receives confirmation from 
the following circumstances : 



HUMAN FLUIDS. 245 

First, The subjects of gout are generally per- 
sons advanced in life, who are naturally of a 
robust, full habit of body, and who have been 
accustomed to a sedentary indolent manner of 
living, a full, voluptuous diet, and the too free 
use of wine or other spirituous and fermented 
liquors.* Women who seldom indulge in habits 
of intemperence in eating and drinking, are as 
seldom the subjects of gout; and when they are 
attacked with this complaint it is usually after 
the cessation of the catamenia, or such as hap- 
pen to be of a robust, corpulent habit of body, 
and at the same time lead a life of indolence 
and intemperance. 

Secondly, " Its associate or vicarious diseases, 
apoplexy, palsy, asthma, habitual catarrh, erup- 
tions on the skin, obstructed viscera, and dropsy., 
arise from the same habit of body, and from the 
same causes."! 

Thirdly, Gout rarely attacks persons who 
live much upon vegetable aliment, or who are 



* Vide Sydenham, Treatise on the Gout. 

i Hosack, Amer.Med. andPbilos. Register, vol, in 



246 PATHOLOGY OF THE 

remarkable for their excessive discharges by the 
skin. Those, too, who are employed in con- 
stant bodily labour, are seldom the subjects of 
this complaint, even though they at the same 
time liberally indulge in the excesses both of the 
table and bottle ; for by active bodily exercise 
the secretions are duly kept up, and the vessels 
thereby prevented from becoming surcharged 
with fluids. 

Fourthly, The collections of Uthiai of soda y 
or other saline or earthy materials, found upon 
the joints in gout, are usually the effects of an 
overloaded condition of the blood-vessels, pro- 
ducing an atony or loss of tone in the secerning 
and excretory vessels, and a consequent impair- 
ed state of the secretions and excretions. 

Lastly, The utility of blood-letting in this 
disease, a practice sanctioned by the truly res- 
pectable authority of Sydenham, Huxham, 
Macbride, Cullen, Rush, and Hosack, is fur- 
ther in proof of its frequent connexion with 
plethora... .. 

Thus much of the diseases of plethora. With 
regard to its cure or prevention little need here 



HUMAN FLUIDS. 247 

be said. As the causes of plethora are intem- 
perance and indolence, so the best means of pre- 
venting this complaint are temperance and ex- 
ercise. But when the disease is already formed,, 
the cure is to be effected by bleeding and other 
evacuants, together with a more abstemious diet, 
and exercise both of body and mind. For as 
the cause of this disease is too much blood, so 
whatever diminishes the quantity of it must also 
diminish the fulness of the vessels. But the 
most ready way of effecting this is by bleeding, 
which immediately relieves all the symptoms of 
plethora. In this respect we are but imitating na- 
ture herself, which often removes an inordinate 
fulness of the vessels by a salutary hemorrhage. 
But as the vessels from being continually over 
distended lose their natural tone and elasticity, 
there are few conditions of the system in which 
irritability and oppression of strength are more 
considerable and troublesome, than in an inordi- 
nate and habitual plethora. To relieve it, there- 
fore, is not unfrequently a task of no small diffi- 
culty. £ * Bleeding, sometimes attended with a lit- 
tle temporary relief, is occasionally followed by 



248 PATHOLOGY OF THE 

fainting; and after a little time the former ful- 
ness, and the debility, with irritability, are increas- 
ed. Evacuations by the intestines, and a feebler 
diet, occasion faintness, and exercise is attended 
with intolerable fatigue. No other plans will, 
however, succeed, and each must be used in such 
a gradual, guarded manner, as to prevent uneasi- 
ness." After the fulness of the vessels have, in 
this manner, been in part diminished, tonics and 
cold bathing may safely and advantageously be 
used. 

We cannot conclude this essay without 
again adverting to the importance of blood-let- 
ting when indicated in the plethora of advanced 
life. Experience, says Dr. Rush, proves it to be 
more necessary, under equal circumstances, in 
that stage of life than in any other. 



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